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People who are structurally disadvantaged and marginalized often report poor health care experiences, such as inequitable treatment, due to intersecting forms of stigma and discrimination. There are many measures of patient experiences of care, however, few are designed to measure equity-oriented health care. In alignment with ongoing calls to integrate actions in support of health equity, we report on the development and testing of patient-reported experience measures that explicitly use a health equity and intersectional lens. Our analysis focuses on two different scales: the Equity-Oriented Health Care Scale—Ongoing, which was evaluated in primary health care settings where patients have an ongoing relationship with providers over time, and the Equity-Oriented Health Care Scale—Episodic, which was tested in an emergency department where care is provided on an episodic basis. Item Response Theory was used to develop and refine the scales. The psychometric properties of each scale were also evaluated. The Equity-Oriented Health Care Scale—Ongoing was first tested with a cohort of 567 patients. The Equity-Oriented Health Care Scale—Episodic was subsequently tested in an emergency department setting with 284 patients. Results of the Item Response Theory analysis for each scale yielded a brief index that captured the level of equity-oriented care when care is ongoing (12 items) or episodic (9 items). Both scales showed evidence of internal consistency and concurrent validity, based on a high correlation with quality of care. They are brief, easy-to-administer patient-reported experience measures that can support organizations to monitor quality of care. Their availability enhances the possibility of measuring equity-oriented health care in diverse contexts and can provide nuanced understandings of quality of care through an intersectional and equity lens. [ABSTRACT FROM AUTHOR]

Our intention is to contribute to the development of Canadian Nursing and Medical Education (NursMed) and efforts to redress deepening, intersecting health and social inequities. This paper addresses the following two research questions: (1) What are the ways in which Decolonial, Intersectional Pedagogies can inform Canadian NursMed Education with a focus on critically examining settler‐colonialism, health equity, and social justice? (2) What are the potential struggles and adaptations required to integrate Decolonial, Intersectional Pedagogies within Canadian NursMed Education in service of redressing intersecting health and social inequities? Briefly, Decolonial, Intersectional Pedagogies are philosophies of learning that encourage teachers and students to reflect on health through the lenses of settler‐colonialism, health equity, and social justice. Drawing on critical ethnographic research methods, we conducted in‐depth interviews with 25 faculty members and engaged in participant observation of classrooms in university‐based Canadian NursMed Education. The research findings are organized into three major themes, beginning with common institutional features influencing pedagogical approaches. The next set of findings addresses the complex strategies participants apply to integrate Decolonial, Intersectional Pedagogies. Lastly, the findings illustrate the emotional and spiritual toll some faculty members face when attempting to deliver Decolonial, Intersectional Pedagogies. We conclude that through the application of Decolonial, Intersectional Pedagogies teachers and students can support movements towards health equity, social justice, and unlearning/undoing settler‐colonialism. This study contributes new knowledge to stimulate dialog and action regarding the role of health professions education, specifically Nursing and Medicine as an upstream determinant of health in settler‐colonial nations such as Canada, United States, Australia, and New Zealand. [ABSTRACT FROM AUTHOR]

Nursing work centers around attending to a person's health during many of life's most vulnerable moments, from birth to death. Given the high‐stakes nature of this work, it is essential for nurses to critically reflect on their individual and collective impact, which can range from healing to harmful. The purpose of this paper is to use a philosophical inquiry approach and a critical lens to explore the potential influence of critical pedagogy (how we learn what we learn) on nursing praxis (why we do what we do) with the aim of disrupting stigma and discrimination within the profession. This paper draws on the works of Paulo Freire, Henry Giroux, and bell hooks to alert readers to particular windows of opportunity where an intentional adoption of critical pedagogy in nursing praxis may help the profession think differently about two important and related topics: relational violence and peer‐led knowledge mobilization. As a practice‐based and theoretically grounded profession, nurses often strive to bridge the theoretical with the practical and the individual with the systemic. Thus, developing a robust and philosophically rooted disciplinary body of knowledge is particularly important to help us defensibly grapple with the notions of truth and ethics that shape our work's very essence and impact. [ABSTRACT FROM AUTHOR]

Background: Despite a publicly funded system, health care in Canada has been shown to be deeply inequitable, particularly toward Indigenous people. Based on research identifying key dimensions of equity-oriented health care as being cultural safety, harm reduction and trauma- and violence-informed care, an intervention to promote equity at the organizational level was tested in primary health care, refined and adapted, and tested in Emergency Departments (EDs).Methods: In partnership with clinical, community and Indigenous leaders in three diverse EDs in one Canadian province, we supported direct care staff to tailor and implement the intervention. Intervention activities varied in type and intensity at each site. Survey data were collected pre- and post-intervention from every consecutive patient over age 18 presenting to the EDs (n = 4771) with 3315 completing post-visit questions in 4 waves at two sites and 3 waves (due to pandemic constraints) at the third. Administrative data were collected for 12 months pre- and 12 months post-intervention.Results: Throughout the study period, the participating EDs were dealing with a worsening epidemic of overdoses and deaths related to a toxic drug supply, and the COVID 19 pandemic curtailed both intervention activities and data collection. Despite these constraints, staff at two of the EDs mounted equity-oriented intervention strategies; the other site was experiencing continued, significant staff shortages and leadership changeover. Longitudinal analysis using multiple regression showed non-significant but encouraging trends in patient perceptions of quality of care and patient experiences of discrimination in the ED. Subgroup analysis showed that specific groups of patients experienced care in significantly different ways at each site. An interrupted time series of administrative data showed no significant change in staff sick time, but showed a significant decrease in the percentage of patients who left without care being completed at the site with the most robust intervention activities.Conclusions: The trends in patient perceptions and the significant decrease in the percentage of patients who left without care being completed suggest potential for impact. Realization of this potential will depend on readiness, commitment and resources at the organizational and systems levels.Trial Registration: Clinical Trials.gov #NCT03369678 (registration date November 18, 2017). [ABSTRACT FROM AUTHOR]

Alarming differences exist in cancer outcomes for people most impacted by persistent and widening health and social inequities. People who are socially disadvantaged often have higher cancer-related mortality and are diagnosed with advanced cancers more often than other people. Such outcomes are linked to the compounding effects of stigma, discrimination, and other barriers, which create persistent inequities in access to care at all points in the cancer trajectory, preventing timely diagnosis and treatment, and further widening the health equity gap. In this commentary, we discuss how growing evidence suggests that people who are considered marginalized are not well-served by the cancer care sector and how the design and structure of services can often impose profound barriers to populations considered socially disadvantaged. We highlight equity-oriented healthcare as one strategy that can begin to address inequities in health outcomes and access to care by taking action to transform organizational cultures and approaches to the design and delivery of cancer services. [ABSTRACT FROM AUTHOR]

Background: As part of a larger study focused on interventions to enhance the capacity of nurses and other health care workers to provide equity-oriented care in emergency departments (EDs), we conducted an analysis of news media related to three EDs. The purpose of the analysis was to examine how media writers frame issues pertaining to nursing, as well as the health and social inequities that drive emergency department contexts, while considering what implications these portrayals hold for nursing practice. Methods: We conducted a search of media articles specific to three EDs in Canada, published between January 1, 2018 and May 1, 2019. Media items (N = 368) were coded by story and theme attributes. A thematic analysis was completed to understand how writers in public media present issues pertaining to nursing practice within the ED context. Results: Two overarching themes were found. First, in ED-related media that portrays health care needs of people experiencing health and social inequities, messaging frequently perpetuates stigmatizing discourses. Second, media writers portray pressures experienced by nurses working in the ED in a way that evades structural determinants of quality of care. Underlying both themes is an absence of perspectives and authorship from practicing nurses themselves. Conclusions: We recommend that frontline nurses be prioritized as experts in public media communications. Nurses must be supported to gain critical media skills to contribute to media, to destigmatize the health care needs of people experiencing inequity who attend their practice, and to shed light on the structural causes of pressures experienced by nurses working within emergency department settings. [ABSTRACT FROM AUTHOR]

Despite ostensibly universal access to health care, many adolescents in countries such as Canada lack access to much-needed mental health and substance use services. There are many complex and interrelated factors that contribute to people’s lack of access to health care services despite living in jurisdictions with universal health care. For example, health inequities shaped by intersecting forms of stigma and discrimination play a significant role in shaping approaches to health care delivery and adolescent access to health care. The idea of intersecting forms of stigma and discrimination draws on the works of Crenshaw (1989), Collins (2022), and others, who identified that various parts of a person’s identity, such as their race, gender, sex, and sexual orientation, may confer privilege, advantage, disadvantage, or oppression depending on a person’s context. Health inequities have been shown to impact physical health, mental health, self-reported perceptions of health status, and access to health care services (Canada, 2020).  Acknowledging these realities, that socially constructed inequities influence health and health care access, is essential for health care providers, policymakers, and researchers to explicitly explore and address, given the insidious and often invisibilized nature of factors that both constitute and contribute to health inequities. In this paper, we present equity-oriented care as a potential path for improving access to adolescent mental health and substance use services. [ABSTRACT FROM AUTHOR]

Background: Globally, health inequities persist with effects on whole populations and the most profound effects on populations marginalized by poverty, discrimination and other forms of disadvantage. In the current neoliberal political-economic context, health inequities are produced and sustained by the inequitable distribution of social determinants of health and structural inequities such as discrimination and institutional racism. Even in the context of healthcare organizations with an explicit commitment to health equity, multiple intersecting discourses, such as ongoing efficiency discourses, and culturalist and racialized discourses, are in constant interaction with healthcare practices at the point of care and the organizational level, limiting providers' and organizations' capacities to address structural inequities. Attention to discourses that sustain inequities in health care is required to mitigate health inequities and related power differentials. In this paper, we present findings from a critical analysis of the relations among multiple discourses and healthcare practices within four Canadian primary health care clinics that have an explicit commitment to health equity.Methods: Informed by critical theoretical perspectives and critical discourse analysis principles, we conducted an analysis of 31 in-depth interviews with clinic staff members. The analysis focused on the relations among discourses and healthcare practices, the ways in which competing discourses influence, reinforce, and challenge current practices, and how understanding these dynamics can be enlisted to promote health equity.Results: We articulate the findings through three interrelated themes: equity-mandated organizations are positioned as the "other" in the health care system; discourses align with structures and policies to position equity at the margins of health care; staff and organizations navigate competing discourses through hybrid approaches to care.Conclusions: This study points to the ways in which multiple discourses interact with healthcare organizations' and providers' practices and highlights the importance of structural changes at the systemic level to foster health equity at the point of care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how marginalised women perceive and rate equity‐oriented health care at a primary care clinic using items that evaluate patients' experiences of care. Background: Despite an increased recognition of the importance of health care that is equity‐oriented, and that understands the patient within the context of the broader social determinants of health, inequities in health remain prevalent around the world. Design: Items from the "EQUIP Primary Health Care" research programme were used to explore patients' experiences of equity‐oriented health care. Women were invited to complete the questionnaire with the explicit aim of gaining their input to improve quality of care at the clinic. The Strengthening the Reporting of Observational Studies in Epidemiology Statement was followed for the study. Methods: Sixty‐seven women who experienced significant health and social inequities, and were seeking care at a women's only nurse practitioner primary health care clinic in Canada, were invited to complete the questionnaire. For quality improvement purposes, correlational analyses were used to explore women's experiences of care. Results: Women's responses showed that Promote Emotional Safety and Trust and Overall Quality of Care were the most highly correlated domains, indicating the importance of the health care team in establishing trusting relationships, particularly for women who experience stigma and negative judgement when seeking care. Conclusion: Seeking feedback from patients on their experiences of care using items developed to explicitly tap into equity issues is useful in understanding how patients experience equity‐oriented health care. Responses from the women highlight the importance of understanding not only the what of equity‐oriented care but also the how. Relevance to clinical practice: The results of this study illustrate the importance of establishing trusting relationships, tailoring care, and using a nondiscriminatory approach when working with women who experience negative judgements when seeking care. [ABSTRACT FROM AUTHOR]

This paper reports on key findings of a critical qualitative inquiry undertaken with an Indigenous early child development (ECD) program in Canada, known as the Aboriginal Infant Development Program (AIDP). In depth, semi-structured interviews were used to obtain the perspectives of: Indigenous caregivers and Elders, AIDP workers, and administrative leaders. The findings centre on: (1) a relational perspective of family wellbeing that emphasises the inseparability between child health inequities and the impact of structural social factors on families’ lives, and (2) how AIDP workers’ enact relational accountability to families by: (a) fostering cultural connections; (b) creating networks of belonging and support; (c) responding to caregivers’ self-identified priorities; (d) mitigating racism in healthcare encounters, and (e) deferring an ‘ECD agenda’. Rather than a one-size-fits-all model, these findings illustrate relational approaches to early intervention, characterised by a broader and socially responsive scope of practice and the deferral of a normative ‘ECD agenda’. This study has relevance in a variety of international contexts and to a broad range of disciplines and programs that serve families and children impacted by structural inequities. [ABSTRACT FROM AUTHOR]

Neoliberal ideology and exclusionary policies based on racialized identities characterize the current contexts in North America and Western Europe. Nursing knowledge cannot be abstracted from social, political and historical contexts; the task of examining the influence of race and racial ideologies on disciplinary knowledge and inquiry therefore remains an important task. Contemporary analyses of the role and responsibility of the discipline in addressing race‐based health and social inequities as a focus of nursing inquiry remain underdeveloped. In this article, we examine nursing's engagement with ideas about race and racism and explore the ways in which nursing knowledge and inquiry have been influenced by race‐based ideological discourses. Drawing on Henry and Tator's framework of democratic racism, we consider how strategic discursive responses—the discourses of individualism, multiculturalism, colour‐blindness, political correctness and denial—have been deployed within nursing knowledge and inquiry to reinforce the belief in an essentially fair and just society while avoiding the need to acknowledge the persistence of racist discourses and ideologies. Greater theoretical, conceptual and methodological clarity regarding race, racialization and related concepts in nursing inquiry is needed to address health and social inequities. [ABSTRACT FROM AUTHOR]

Although nursing has a unique contribution to advancing social justice in health care practices and education, and although social justice has been claimed as a core value of nursing, there is little guidance regarding how to enact social justice in nursing practice and education. In this paper, we propose a critical antidiscriminatory pedagogy (CADP) for nursing as a promising path in this direction. We argue that because discrimination is inherent to the production and maintenance of inequities and injustices, adopting a CADP offers opportunities for students and practicing nurses to develop their capacity to counteract racism and other forms of individual and systemic discrimination in health care, and thus promote social justice. The CADP we propose has the following features: it is grounded in a critical intersectional perspective of discrimination, it aims at fostering transformative learning, and it involves a praxis‐oriented critical consciousness. A CADP challenges the liberal individualist paradigm that dominates much of western‐based health care, and the culturalist and racializing processes prevalent in nursing education. It also situates nursing practice as responsive to health inequities. Thus, a CADP is a promising way to translate social justice into nursing practice and education through transformative learning. [ABSTRACT FROM AUTHOR]

This article is part of a larger study that explored how an Indigenous early intervention programme in British Columbia ( BC), Canada, known as the 'Aboriginal Infant Development Program' ( AIDP), influenced family and children's health and well-being and was responsive to child health inequities. Postcolonial feminist and Indigenous feminist perspectives provided a critical analytical lens to this qualitative inquiry. The study was undertaken with AIDPs based in diverse community organisations located in off-reserve urban municipalities throughout the province of BC. From September 2013 to March 2014, in-depth, semi-structured interviews were undertaken with: Indigenous primary caregivers ( n = 10), Indigenous Elders ( n = 4), AIDP workers ( n = 18) and administrative leaders ( n = 3). The purpose of this article is to examine and analyse the findings that focus on how AIDP workers supported family and children's health and well-being by transforming their routine policies and practices in ways that fostered caregivers' active engagement in their programmes. Findings centre on three main themes: (i) overcoming mistrust; (ii) 'being willing to move a step forward' and (iii) resisting what's taken-for-granted. These inter-related themes are examined and discussed in relation to the concept of cultural safety. The findings have international relevancy for social and healthcare community-based programmes that are questioning how to engage with parents who may be hard to reach as a result of multi-faceted social and structural factors. [ABSTRACT FROM AUTHOR]

Objective In Canada, primary care reform has encouraged innovations, including nurse practitioners (NPs) and group medical visits (GMVs). NP-led GMVs provide an opportunity to examine barriers and enablers to implementing this innovation in primary care. Design An instrumental case study design (n=3): two cases where NPs were using GMVs and one case where NPs were not using GMVs, was completed. In-depth interviews with patients and providers (N=24) and 10 hours of direct observation were completed. Interpretive descriptive methods were used to analyse data. Results/Findings Two main themes were identified: (i) acquisition of knowledge and (ii) GMVs help shift relationships between patients and health-care providers. Participants discussed how patients and providers learn from one another to facilitate self-management of chronic conditions. They also discussed how the GMV shifts inherent power differentials between providers and between patients and providers. Discussion NP-led GMVs are a method of care delivery that harness NPs' professional agency through increased leadership and interprofessional collaboration. GMVs also facilitate an environment that is patient-centred and interprofessional, providing patients with increased confidence to manage their chronic conditions. The GMV provides the opportunity to meet both team-based and patient-centred health-care objectives and may disrupt inherent power differentials that exist in primary care. [ABSTRACT FROM AUTHOR]

Background: Structural violence shapes the health of Indigenous peoples globally, and is deeply embedded in history, individual and institutional racism, and inequitable social policies and practices. Many Indigenous communities have flourished, however, the impact of colonialism continues to have profound health effects for Indigenous peoples in Canada and internationally. Despite increasing evidence of health status inequities affecting Indigenous populations, health services often fail to address health and social inequities as routine aspects of health care delivery. In this paper, we discuss an evidence-based framework and specific strategies for promoting health care equity for Indigenous populations. Methods: Using an ethnographic design and mixed methods, this study was conducted at two Urban Aboriginal Health Centres located in two inner cities in Canada, which serve a combined patient population of 5,500. Data collection included in-depth interviews with a total of 114 patients and staff (n = 73 patients; n = 41 staff), and over 900 h of participant observation focused on staff members' interactions and patterns of relating with patients. Results: Four key dimensions of equity-oriented health services are foundational to supporting the health and well-being of Indigenous peoples: inequity-responsive care, culturally safe care, trauma- and violence-informed care, and contextually tailored care. Partnerships with Indigenous leaders, agencies, and communities are required to operationalize and tailor these key dimensions to local contexts. We discuss 10 strategies that intersect to optimize effectiveness of health care services for Indigenous peoples, and provide examples of how they can be implemented in a variety of health care settings. Conclusions: While the key dimensions of equity-oriented care and 10 strategies may be most optimally operationalized in the context of interdisciplinary teamwork, they also serve as health equity guidelines for organizations and providers working in various settings, including individual primary care practices. These strategies provide a basis for organizational-level interventions to promote the provision of more equitable, responsive, and respectful PHC services for Indigenous populations. Given the similarities in colonizing processes and Indigenous peoples' experiences of such processes in many countries, these strategies have international applicability. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to develop a core set of indicators that could be used for measuring and monitoring the performance of primary health care organizations' capacity and strategies for enhancing equity-oriented care. Methods: Indicators were constructed based on a review of the literature and a thematic analysis of interview data with patients and staff (n = 114) using procedures for qualitatively derived data. We used a modified Delphi process where the indicators were circulated to staff at the Health Centers who served as participants (n = 63) over two rounds. Indicators were considered part of a priority set of health equity indicators if they received an overall importance rating of>8.0, on a scale of 1–9, where a higher score meant more importance. Results: Seventeen indicators make up the priority set. Items were eliminated because they were rated as low importance (<8.0) in both rounds and were either redundant or more than one participant commented that taking action on the indicator was highly unlikely. In order to achieve health care equity, performance at the organizational level is as important as assessing the performance of staff. Two of the highest rated “treatment” or processes of care indicators reflects the need for culturally safe and trauma and violence-informed care. There are four indicators that can be used to measure outcomes which can be directly attributable to equity responsive primary health care. Discussion: These indicators and subsequent development of items can be used to measure equity in the domains of treatment and outcomes. These areas represent targets for higher performance in relation to equity for organizations (e.g., funding allocations to ongoing training in equity-oriented care provision) and providers (e.g., reflexive practice, skill in working with the health effects of trauma). [ABSTRACT FROM AUTHOR]

ObjectiveFollowing arguments made in the USA, the UK and New Zealand regarding the importance of population-level ethnicity data in understanding health and healthcare inequities, health authorities in several Canadian provinces are considering plans to collect ethnicity data from patients at the point of care within selected healthcare organizations. The purpose of this paper is to examine the potential quality, utility and relevance of ethnicity data collected at an organizational level as a means of addressing health and healthcare inequities. DesignWe draw on findings from a recent Canadian study that examined the implications of collecting ethnicity data in healthcare contexts. Using a qualitative design, data were collected in a large city, and included interviews with 104 patients, community and healthcare leaders, and healthcare workers within diverse clinical contexts. Data were analyzed using interpretive thematic analysis. ResultsOur results are discussed in relation to discourses reflected in the current literature that require consideration in relation to the potential utility and relevancy of ethnicity data collected at the point of care within healthcare organizations. These discourses frame excerpts from the ethnographic data that are used as illustrative examples. Three key challenges to the potential relevance and utility of ethnicity data collected at the level of local healthcare organizations are identified: (a) issues pertaining to quality of the data, (b) the fact that data quality is most problematic for those with the greatest vulnerability to the negative effects of health inequities, and (c) the lack of data reflecting structural disadvantages or discrimination. ConclusionThe quality of ethnicity data collected within healthcare organizations is often unreliable, particularly for people from racialized or visible minority groups, who are most at risk, seriously limiting the usefulness of the data. Quality measures for collecting data reflecting ethnocultural identity in specific healthcare organizations may be warranted – but only if mechanisms exist or are developed for linking ethnicity with measures of perceived discrimination, stigmatization, income level, and other known contributors to inequities. Methods for linking these kinds of data, however, remain underdeveloped or non-existent in most healthcare organizations. [ABSTRACT FROM AUTHOR]

Introduction: International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods: The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments. Results: Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions: These evidence- and theoretically-informed key dimensions and strategies provide direction for PHC organizations aiming to redress the increasing levels of health and health care inequities across population groups. The findings provide a framework for conceptualizing and operationalizing the essential elements of equity-oriented PHC services when working with marginalized populations, and will have broad application to a wide range of settings, contexts and jurisdictions. Future research is needed to link these strategies to quantifiable process and outcome measures, and to test their impact in diverse PHC settings. [ABSTRACT FROM AUTHOR]

Background: Using our research findings, we explore Harm Reduction and Methadone Maintenance Treatment (MMT) using an intersectional lens to provide a more complex understanding of Harm Reduction and MMT, particularly how Harm Reduction and MMT are experienced differently by people dependent on how they are positioned. Using the lens of intersectionality, we refine the notion of Harm Reduction by specifying the conditions in which both harm and benefit arise and how experiences of harm are continuous with wider experiences of domination and oppression; Methods: A qualitative design that uses ethnographic methods of in-depth individual and focus group interviews and naturalistic observation was conducted in a large city in Canada. Participants included Aboriginal clients accessing mainstream mental health and addictions care and primary health care settings and healthcare providers; Results: All client-participants had profound histories of abuse and violence, most often connected to the legacy of colonialism (e.g., residential schooling) and ongoing colonial practices (e.g., stigma & everyday racism). Participants lived with co-occurring illness (e.g., HIV/AIDS, Hepatitis C, PTSD, depression, diabetes and substance use) and most lived in poverty. Many participants expressed mistrust with the healthcare system due to everyday experiences both within and outside the system that further marginalize them. In this paper, we focus on three intersecting issues that impact access to MMT: stigma and prejudice, social and structural constraints influencing enactment of peoples' agency, and homelessness; Conclusions: Harm reduction must move beyond a narrow concern with the harms directly related to drugs and drug use practices to address the harms associated with the determinants of drug use and drug and health policy. An intersectional lens elucidates the need for harm reduction approaches that reflect an understanding of and commitment to addressing the historical, socio-cultural and political forces that shape responses to mental illness/ health, addictions, including harm reduction and methadone maintenance treatment. [ABSTRACT FROM AUTHOR]

SALMON A, BROWNE AJ, and PEDERSON A. Nursing Inquiry 2010; : 336-345 In this paper, we discuss and analyse the strategies employed and challenges encountered when conducting a recent feminist participatory action research study with highly marginalized women who were illicit drug users in an inner city area of Vancouver, Canada. Through an analysis of the political economy of participatory praxis within current neoliberal contexts, we focus on three main areas: (i) reconceptualizing the pragmatics of participation; (ii) the microeconomic implications of participatory research, including ethical issues in payment for research participation; and (iii) the value and limits of using research as a tool for activism and empowerment. We conclude with a brief discussion of what we see to be some of the most salient social justice implications arising from feminist and participatory approaches to health research within neoliberal political spaces. [ABSTRACT FROM AUTHOR]

BROWNE AJ, HARTRICK DOANE G, REIMER J, MacLEOD MLP and McLELLAN E. Nursing Inquiry 2010; 17: 26–37 Public health nursing practice with ‘high priority’ families: the significance of contextualizing ‘risk’ Public health nurses (PHNs) play a vital role in supporting families at risk; few studies, however, have focused on how PHNs actually work with families to provide support, build trust, and use their clinical judgment to make decisions in complex, at-risk situations. In this study, we report on findings from research that illustrate how PHNs use relational approaches in their work with ‘high priority’ families. Drawing on data collected from interviews and focus groups with 32 PHNs, we discuss three central features inherent to working relationally with families at risk: (i) contextualizing the complexities of families’ lives; (ii) responding to shifting contexts of risk and capacity; and (iii) working relationally with families under surveillance. These findings show that the ability to recognize risk and capacity as intersecting aspects of families’ lives, and to practice from a stance that recognizes risk as contextualized is foundational to effective working relationships with high-priority families. [ABSTRACT FROM AUTHOR]

The increasingly high rates of mortality and morbidity among Canadian Aboriginal women who are living with HIV/AIDS indicate that there is a need to address deficiencies in the delivery of supportive services and health care. The purpose of this qualitative study was to develop a greater understanding of the barriers, challenges, and successes experienced when accessing health and related support services from the perspective of Aboriginal women living with HIV/AIDS. The findings are organized around four themes reflected in the interview data: fear of rejection when seeking services, finding strength in adversity, struggles with symptoms, and HIV as just one of many competing problems. It is anticipated that the findings from the study will be used to inform decision making regarding the development and delivery of appropriate, responsive, and accessible policies and programs that will support Aboriginal women who are living with HIV/AIDS. [ABSTRACT FROM AUTHOR]

Although ethnicity data are collected in most countries at the population level, it has become more common to collect such data in healthcare settings, partially in response to growing health and social inequities worldwide. However, the implications of doing so have not been studied. This two-year study was designed to critically examine the implications of collecting ethnicity data in healthcare settings. Using a critical ethnographic approach, we interviewed 104 patients, community and healthcare leaders, and healthcare workers within diverse clinical contexts in a large city in Western Canada in 2006–2007. This paper presents an interpretive thematic analysis, using an ethical lens, of the harms and benefits associated with the process of data collection in a clinical context. While most leaders and healthcare workers and some patients envisioned potential benefits associated with having ethnicity data, these benefits were seen as largely contingent upon action being taken to ameliorate inequities. Overwhelmingly, however, leaders from ethno-cultural communities and patients of diverse identities anticipated potential harm arising both from having ethnicity data and the process of collection. The analysis illustrates that in today's sociopolitical context, collecting ethnicity data in clinical contexts may engender considerable harm, particularly for racialized, vulnerable patients. If ethnicity data are currently collected at the population level, evidence of benefit is required before proceeding to collect these data at the point of care. [Copyright &y& Elsevier]

Nurse practitioners (NPs) are increasingly called on to provide high-quality health-care particularly for people who face significant barriers to accessing services. Although discourses of social justice have become relatively common in nursing and health services literature, critical analyses of how NP roles articulate with social justice issues have received less attention. In this study, we examine the role of NPs from a critical social justice perspective. A critical social justice lens raises morally significant questions, for example, why certain individuals and groups bear a disproportionate burden of illness and suffering; what social conditions contribute to disparities in health and social status; and what social mandate NPs ought to develop in response to these realities. In our analysis, we draw on lessons learned from the initial Canadian experience with the introduction of NPs in the 1970s to consider the renewed and burgeoning interest in NPs in Canada, Australia and elsewhere. As we argue, a critical social justice perspective (in addition to the biomedical foci of NP practice) will be essential to sustaining long-term, socially responsive NP roles and achieving greater equity in health and health-care. [ABSTRACT FROM AUTHOR]

Abstract: Based on findings from an ethnographic study, this paper explores the sociopolitical context of nurses’ encounters with First Nations women in a Western Canadian hospital. Data were collected using in-depth interviews and participant observation of clinical encounters involving nurses and First Nations women who were in-patients in the hospital. Four themes in the data are discussed: relating across presumed “cultural differences”; constructing the Other; assumptions influencing clinical practice; and responding to routine patient requests. The findings illustrate how discourses and assumptions about Aboriginal people, culture, and presumed differences can become interwoven into routine clinical encounters. These results highlight the importance of analyzing health-care encounters in light of the wider sociopolitical and historical forces that give rise to racialization, culturalism and Othering, and underscore the need for critical awareness of these issues among nurses and other heath-care providers. [Copyright &y& Elsevier]

Determines the social determinants of preventive cancer screening use in British Columbia. Increase access of patients to health care system; Factors contributing to poor health and poor quality of life; Reduction of cancer mortality and morbidity following preventive screening.

The influence of liberal political ideology on nursing science Previous notions of science as impartial and value-neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy — individualism, egalitarianism, freedom, tolerance, neutrality, and a free-market economy — are primarily manifested in relation to: (i) the individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health. [ABSTRACT FROM AUTHOR]

Health care encounters are important areas for study because they reflect social, political, economic, and ideological relations between patients and the dominant health care system. This study examines mainstream health care encounters from the viewpoint of First Nations women from a reserve community in northwestern Canada. Perspectives from critical medical anthropology and the concept of cultural safety provided the theoretical orientation for the study. Critical and feminist ethnographic approaches were used to guide in-depth interviews conducted with 10 First Nations women. Findings were organized around two broad themes that characterized women's descriptions of "invalidating" and "affirming" encounters. These narratives revealed that women's encounters were shaped by racism, discrimination, and structural inequities that continue to marginalize and disadvantage First Nations women. The women's health care experiences have historical, political, and economic significance and are reflective of wider postcolonial relations that shape their everyday lives. [ABSTRACT FROM AUTHOR]

Despite high rates of smoking among socioeconomically disadvantaged pregnant women, few tobacco cessation programs have been geared for this client group. This article(n1) describes newly developed strategies for addressing tobacco reduction with disadvantaged, high-risk prenatal clients enrolled in a community-based Pregnancy Outreach Program in a northern Canadian city. The new tobacco reduction strategies were based on "solution-focused" approaches to interviewing and counseling. Process evaluations conducted with program staff revealed that solution-focused approaches provided effective, client-centered, respectful ways of discussing tobacco reduction with disadvantaged clients. Solution-focused approaches also positively impacted clients' sense of self-efficacy regarding tobacco reduction. The benefits of using solution-focused approaches as an alternative approach to tobacco reduction with disadvantaged prenatal clients are discussed. [ABSTRACT FROM AUTHOR]

This article is based on an ethnographic study exploring Indigenous women's experiences of leaving intimate partner violence. Analysis draws attention to the contextual features of Indigenous women's lives that differentially shaped women's experiences of "leaving and/or staying" with an abusive partner. Our findings are identified and described across four intersecting thematic areas: (a) the context of state-Indigenous relations; (b) complex trauma, stigma, and discrimination; (c) kinship and ties to communities and the land; and (d) health, healing, and resistance. These findings offer valuable insights into what constitutes appropriate, safe services, and support for the Indigenous women whose lives are shaped by multiple forms of violence. [ABSTRACT FROM AUTHOR]

Indigenous women globally are subjected to high rates of multiple forms of violence, including intimate partner violence (IPV), yet there is often a mismatch between available services and Indigenous women's needs and there are few evidence-based interventions specifically designed for this group. Building on an IPV-specific intervention (Intervention for Health Enhancement After Leaving [iHEAL]), "Reclaiming Our Spirits" (ROS) is a health promotion intervention developed to address this gap. Offered over 6 to 8 months in a partnership between nurses and Indigenous Elders, nurses worked individually with women focusing on six areas for health promotion and integrated health-related workshops within weekly Circles led by an Indigenous Elder. The efficacy of ROS in improving women's quality of life and health was examined in a community sample of 152 Indigenous women living in highly marginalizing conditions in two Canadian cities. Participants completed standard self-report measures of primary (quality of life, trauma symptoms) and secondary outcomes (depressive symptoms, social support, mastery, personal agency, interpersonal agency, chronic pain disability) at three points: preintervention (T1), postintervention (T2), and 6 months later (T3). In an intention-to-treat (ITT) analysis, Generalized Estimating Equations (GEE) were used to examine hypothesized changes in outcomes over time. As hypothesized, women's quality of life and trauma symptoms improved significantly pre- to postintervention and these changes were maintained 6 months later. Similar patterns of improvement were noted for five of six secondary outcomes, although improvements in interpersonal agency were not maintained at T3. Chronic pain disability did not change over time. Within a context of extreme poverty, structural violence, and high levels of trauma and substance use, some women enrolled but were unable to participate. Despite the challenging circumstances in the women's lives, these findings suggest that this intervention has promise and can be effectively tailored to the specific needs of Indigenous women. [ABSTRACT FROM AUTHOR]

Background: The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care. Methods: The theoretically-informed and evidence-based intervention known as 'EQUIP' included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics' organizational processes and priorities, and on staff. Results: Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact. Conclusions: This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens. [ABSTRACT FROM AUTHOR]

Background: The advent of highly tolerable and efficacious direct-acting antiviral (DAA) medications has transformed the hepatitis C virus (HCV) treatment landscape. Yet, people who inject drugs (PWID) – a population with inequitably high rates of HCV and who face significant socio-structural barriers to healthcare access – continue to have disproportionately low rates of DAA uptake. The objective of this study is to explore how PWID with lived experience of HCV perceive and experience DAA treatment, in a setting with universal coverage of these medications since 2018. Methods: Informed by a critical interpretive framework, we thematically analyze data from in-depth, semi-structured interviews conducted between January and June 2018 in Vancouver, Canada, with a purposive sample (n = 56) of PWID at various stages (e.g., pre, peri, post) of DAA treatment. Results: The analysis yielded three key themes: (i) life with HCV, (ii) experiences with and perceptions of evolving HCV treatments, and (iii) substance use and the uptake of DAA treatments. First, participants described how health and healthcare conditions, such as the deprioritizing of HCV (e.g., due to: being asymptomatic, healthcare provider inaction, gatekeeping) and catalysts to care (e.g., symptom onset, treatment for co-morbidities) shaped DAA treatment motivation and access. Second, participants described how individual and community-level accounts of evolving HCV treatments, including skepticism following negative experiences with Interferon-based treatment and uncertainty regarding treatment eligibility, negatively influenced willingness and opportunities to access DAAs. Concurrently, participants described how peer and community endorsement of DAAs was positively associated with treatment uptake. Third, participants favoured HCV care that was grounded in harm reduction, which included the integration of DAAs with other substance use-related services (e.g., opioid agonist therapy, HIV care), and which was often contrasted against abstinence-focused care wherein substance use is framed as a contraindication to HCV treatment access. Conclusions: These findings underscore several equity-oriented healthcare service delivery and clinician adaptations that are required to scale up DAAs among PWID living with HCV, including the provision of harm reduction-focused, non-stigmatizing, integrated, and peer-led care that responds to power differentials. [ABSTRACT FROM AUTHOR]

Building on trauma-informed care (TIC), Trauma and Violence-Informed Care (TVIC) aims to minimize re-traumatization for people who have previously experienced violence, support people currently experiencing violence and draw attention to structural violence. Previous research has not explored how health care providers understand TVIC nor studied either TIC or TVIC in primary health care (PHC). This analysis of the perspectives of fourteen PHC staff regarding the impacts of interprofessional TVIC education sessions was conducted as part of a larger study of an intervention to promote equity in PHC. Researchers drew on general clinic observations and observations of TVIC training sessions and analyzed in-depth interviews with PHC staff who took part in TVIC training, using an interpretive description approach. While the impacts varied, all participants described enhancements in their knowledge, awareness and/or confidence in providing care related to trauma and violence. Factors intrinsic to the process of educating staff, including providing staff with data on trauma and violence in the patient population, and supporting interprofessional discussions, influenced how participants understood, integrated, and prioritized TVIC. Importantly, structural, organizational, and personal contexts significantly influenced how participants enacted TVIC in practice. This study contributes knowledge about interprofessional TVIC education and how diverse professionals understand and enact TVIC concepts in PHC, pointing to the role of TVIC in challenging the biomedical paradigm in PHC and the difficulties of using a structural lens in clinical practice. [ABSTRACT FROM AUTHOR]

Presents the response of Annette J. Brown to criticisms regarding her paper "Influence of Liberal Political Ideology on Nursing Science" published in the 2001 issue of "Nursing Inquiry." Claims of Brown that subjectively derived knowledge is required to address the diverse experiences and unique responses in patients; Importance of studying the intersecting factors that shape experiences; Limits to the influence of liberal values on nursing theories.

Background: Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada. Methods: A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context. Results: Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions. Conclusion: Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change. [ABSTRACT FROM AUTHOR]

Aboriginal and Torres Strait Islander (Aboriginal) young people seek information and access health services for their sexual health needs. This study examined Aboriginal young people's perspectives on sexual health services and sex education in Australia. Overall, 51 Aboriginal people aged 16–26 years were interviewed by peer researchers in Sydney, Australia in 2019–2020. The findings suggest that the internet was used to assess information quickly and confidentially, but Aboriginal young people questioned its reliability and accuracy. Family, Elders and peers were seen as sources of advice because they had real-life experience and highlighted intergenerational learning that occurs in Aboriginal communities. School-based sex education programmes had mixed reviews, with a preference for programmes delivered by external specialists providing anonymity, clear and accurate information about sex and relationships and positive approaches to sex education, including how to gain consent before sex. There was a need identified for school-based programmes to better consider the needs of Aboriginal young people, including those who identified as LGBTQI +. Aboriginal Medical Services were highly valued for providing culturally safe access to services, while sexual health clinics were valued for providing specialised confidential clinical services with low levels of judgement. [ABSTRACT FROM AUTHOR]

In Canada, increasing numbers of people with chronic conditions have prompted calls for innovative approaches to delivering primary care. These approaches may include group medical visits (GMVs) and the introduction of nurse practitioners (NPs). We examined why NPs in the province of British Columbia were not using GMVs. This case study is part of a larger research project that examined the impact of GMVs with NPs for patients with chronic conditions. We completed open-ended interviews with seven NPs working in primary care. Interviews were audiotaped and transcribed. Data were analyzed using interpretive descriptive approaches. Three major themes emerged: (a) advantages of GMVs, (b) questioning the fit of GMVs in current practice contexts, and (c) navigating scope of practice and role constraints that affect NPs’ ability to use GMVs. Power dynamics and hierarchies may influence NPs’ ability to adapt to GMVs. Consideration of practice environments and structures that enable the NPs ability to diffuse and utilize health-care innovative care delivery methods is needed. [ABSTRACT FROM AUTHOR]

Background: Accessing cancer treatment requires First Nation peoples living in rural and remote communities to either commute to care, or to relocate to an urban centre for the length or part of the treatment. While Canadians living in rural and remote communities must often make difficult decisions following a cancer diagnosis, such decisions are further complicated by the unique policy and socio-historical contexts affecting many First Nation peoples in Canada. These contexts often intersect with negative healthcare experiences which can be related to jurisdictional confusion encountered when seeking care. Given the rising incidence of cancer within First Nation populations, there is a growing potential for negative health outcomes.Methods: The analysis presented in this paper focuses on the experience of First Nation peoples' access to cancer care in the province of Manitoba. We analyzed policy documents and government websites; interviewed individuals who have experienced relocation (N = 5), family members (N = 8), healthcare providers and administrators (N = 15).Results: Although the healthcare providers (social workers, physicians, nurses, patient navigators, and administrators) we interviewed wanted to assist patients and their families, the focus of care remained informed by patients' clinical reality, without recognition of the context which impacts and constrains access to cancer care services. Contrasting and converging narratives identify barriers to early diagnosis, poor coordination of care across jurisdictions and logistic complexities that result in fatigue and undermine adherence. Providers and decision-makers who were aware of this broader context were not empowered to address system's limitations.Conclusions: We argue that a whole system's approach is required in order to address these limitations. [ABSTRACT FROM AUTHOR]

Background: Group medical visits (GMVs), clinical encounters with a medical component delivered to groups of patients, have emerged as an innovative approach to potentially increasing efficiency while enhancing the quality of primary health care (PHC). GMVs have created the need to pay explicit attention to patient confidentiality. Objective: What strategies are used by providers and patients to address issues of confidentiality within GMVs? Design: In‐depth interviews were conducted with 34 PHC providers and 29 patients living in nine rural communities in British Columbia, Canada. Data were analysed using interpretive thematic analysis and a relational autonomy approach. Results: We found three main themes: (i) choosing to disclose: balancing benefits and drawbacks of GMVs, (ii) maintaining confidentiality in GMVs and (iii) gaining strength from interdependent relationships: patients learning from each other. Confidentiality can be addressed and was not a major concern for patients attending or providers facilitating GMVs in these rural communities. Discussion: Patients adopted strategies to address their own and others' concerns related to confidential health information. Providers used multiple strategies to maintain confidentiality within the group, including renegotiating what information is shared and providing examples of what information ought to be kept confidential. Conclusions: Although GMVs are not for all patients, a relational autonomy approach is useful in drawing attention to the context and structures which may influence their patients' ability to act autonomously. Successful delivery of GMVs requires both patients and providers to negotiate between maintaining confidentiality and an appropriate level of disclosure. [ABSTRACT FROM AUTHOR]

This study documents the policy framework that shapes First Nations' experience of relocating to access medical care. We analyzed policy documents and government websites, interviewed individuals who have experienced relocation, family members, healthcare providers, health administrators, and conducted two focus groups with government representatives. Federal and provincial program managers interpret policies, make decisions on eligibility, to extend or deny coverage. Decisions are shaped by shrinking budgets, fragmented program coverage, and jurisdictional confusion. Provider advocacy can help, but also perpetuate perceptions of arbitrariness and distrust. National policy renewal is required to redress this issue. [ABSTRACT FROM AUTHOR]

At the point of entry to the health care system sit general practice receptionists (GPRs), a seldom studied employment group. The place of the receptionist involves both a location within the internal geography of the clinic and a position within the primary care team. Receptionists literally ‘receive’ those who phone or enter the clinic, and are a critical influence in their transformation from a ‘person’ to a ‘patient’. This process occurs in a particular space: the ‘waiting room’. We explore the waiting room and its dynamics in terms of ‘acceptability’, an under-examined aspect of access to primary care. We ask ‘ How do GPRs see their role with regard to patients with complex health and social needs, in light of the spatio - temporal constraints of their working environments?’ We engaged receptionists as participants to explore perceptions of their roles and their workspaces, deriving narrative data from three focus groups involving 14 GPRs from 11 practices in the Northland region of New Zealand. The study employed an adapted form of grounded theory. Our findings indicate that GPRs are on the edge of the practice team, yet carry a complex role at the frontline, in the waiting space. They are de facto managers of this space; however, they have limited agency within general practice settings, due to the constraints imposed upon them by physical and organisational structures. The agency of GPRs is most evident in their ability to shape the social dynamics of the waiting space, and to frame the health care experience as positive for people whose usual experience is marginalisation. We conclude that, if well supported, receptionists have the potential to positively influence health care acceptability, and patients' access to care. [ABSTRACT FROM AUTHOR]

Aims To report findings from a study examining the impact of the threat of child removal on Aboriginal women's experiences accessing of healthcare services. Background A wealth of data highlights the higher proportion of Aboriginal children in government care in Canada compared with non-Aboriginal children. Aboriginal women experience poorer health outcomes than non-Aboriginal women and face significant barriers to healthcare access. However, little is known about how these phenomena may intersect. Design The study was conducted in two phases: (1) a secondary analysis of interviews with Aboriginal women and healthcare providers ( n = 7) that were collected for a larger study; and (2) primary interviews with Aboriginal women ( n = 9) and healthcare providers ( n = 8), conducted between July-October 2011. Methods Postcolonial feminist perspectives and the principles of exploratory, qualitative research guided this ethnographic study. Data were analysed using principles of thematic analysis and interpretive description. Findings Aboriginal women whose children are involved with the child protection system often experience complex sociopolitical and economic challenges, which intersect with the threat of apprehension. Such threat did not impact women's decisions to seek healthcare services for their children, but experiences of racism, prejudice and discrimination in mainstream healthcare agencies and the fear of child apprehension influenced their decisions to access health care for themselves in ways that deterred access. Conclusion Racism, judgment and discrimination towards Aboriginal mothers in healthcare agencies must be addressed. Educating healthcare providers about culturally safe approaches to care is critical to mitigating the ongoing impact of colonialism and its effects on health of Aboriginal people. [ABSTRACT FROM AUTHOR]

Background: The advent of direct-acting antiviral (DAA) medications has facilitated opportunities to treat hepatitis C virus (HCV) among people who inject drugs (PWID). However, there remains a need for data about how to optimally support PWID throughout DAA post-treatment trajectories, including with regard to re-infection prevention. The objective of this study is therefore to identify how PWID with lived experience of HCV describe their expectations and experiences related to health and social outcomes, contexts, and substance use practices following completion of DAA treatment.Methods: We thematically analyzed data from in-depth, semi-structured interviews, conducted between January and June 2018, in Vancouver, Canada, with a purposive sample (n = 50) of PWID at various stages of DAA treatment (e.g., pre, peri, post).Results: Our analysis yielded three themes. First, while participants had hoped to experience holistic enhancements in wellbeing following HCV cure, discussions of actual post-treatment experiences tended to be located in physical health (e.g., increased energy). Second, participants often pointed to the ways in which HCV-related and other stigmas had restricted opportunities for health and healthcare access. Participants therefore identified stigma-reduction as a key motivator of HCV cure, and while reductions in internalized stigma were sometimes achieved, participants underscored that other forms of enacted stigma (e.g., related to: substance use, HIV, poverty) had continued to feature prominently in their post-treatment lives. Third, participants described considerable knowledge about how to prevent HCV re-infection following cure, but they also expressed apprehensiveness about how socio-structural barriers, including stigma and criminalization, could interfere with harm reduction and re-infection prevention efforts.Conclusions: DAAs are transforming the health and wellbeing of some PWID. Yet, HCV-related policy must extend beyond the scale-up of DAAs to include concerted public health investments, including anti-stigma efforts and improvements to the social welfare system, to meaningfully advance equity in PWID's post-treatment trajectories and outcomes. [ABSTRACT FROM AUTHOR]

Othering is a process that identities those that are thought to be different from oneself or the mainstream, and it can reinforce and reproduce positions of domination and subordination. Although there are theoretical and conceptual treatments of othering in the literature, researchers tack sufficient examples of othering practices that influence the interactions between patients and health care providers. The purpose of this study was to explore the interactions between health care providers and South Asian immigrant women to describe othering practices and their effects. Ethnographic methods were used involving in-depth interviews and focus group discussions. The analysis entailed identifying uses of othering and exploring the dynamics through which this process took place. Women shared stories of how discriminatory treatment was experienced. The interviews with health care professionals provided examples of how views of South Asian women shaped the way health care services were provided. Three forms of othering were found in informants' descriptions of their problematic health earn encounters: essentializing explanations, culturalist explanations, and racializing explanations. Women's stories illustrated ways of coping and managing othering experiences. The analysis also revealed how individual interactions are influenced be the social anti institutional contexts that create conditions for othering practices. To luster safe and effective health care interactions, those in power must Continue to unmask othering practices and transform health care environments to support truly equitable health care. [ABSTRACT FROM AUTHOR]