Table 3 Key informant views about person-centred OA care for diverse women

Foster a healing relationship

welcoming manner, eye contact, casual friendly conversation, active listening

[The doctor] asked me how are you feeling? How I can help you? Giving me the good smiling face. And then when I’m explaining, she’s listening carefully what I’m trying to tell her (21 woman Pakistani age 65)

They were all polite to me…they welcomed me, and they did listen to my problems and I was happy about that (15 woman African age 45)

Building rapport by facing the person, having good eye contact, making sure that they hear and understand what I’m saying… (17 family physician late career)

I usually talk about personal stuff…food and all that kind of stuff and I really get to know them or their family member. I like to ask about their day-to-day and what they do. I just try to get to know them on a human level (16 chiropractor early career)

I’m not aware of any proactive policies that help build relationships…I can’t think of a policy that either is specific to women or to marginalized groups (15 policymaker quality improvement late career)

Exchange information

explore the impact of OA on daily life

He asked me what are my activities? Am I mostly staying at home just doing chores and not exercising (10 woman Filipino age 48)

A lot of the questions involved the impact that the knee was having on my work..what is it that you want to do in your life and how is it being impacted (06 woman Caucasian age 65)

Sometimes people are more forthcoming with their goals of the treatment session or where they want to improve in their life, what sort of activities they want to get better at or resume or work towards. Sometimes it’s not evident and needs to be specifically asked (01 physiotherapist late career)

You need to understand what their daily routine is like. What is it that you do, how do you spend your day? They’ll tell you if it’s assembly work, if they’re working in an office, if they’re sitting a lot of the time or if they’re at home looking after 8 children (25 pharmacist mid career)

I know there’s some work being done and greater attention being put onto how to meet the needs of a diverse audience. I think a lot of this probably still in its infancy…I can’t point to anything that I’m aware of that has would be a strong resource for women (31 executive late career)

Address emotions

ask about and acknowledge the emotional impact of OA, and offer reassurance or referrals to other healthcare professionals

If I am feeling down because of my health problem, then [the doctor] talks to me and she would spend more time during my visit and talk to me about that…. And she kept on saying that if I am feeling down again, just make an appointment, she will talk to me again (23 woman Chinese age 70)

She described about this is a chronic process and it will progress with the time. But with the management, healthy lifestyle and weight reduction, we can delay this process (22 woman Pakistani age 57)

I think we do this with everybody. We ask how they’re managing and what kind of support they have and what that impact is like (10 occupational therapist late career)

Tell them it must be so hard and I understand how it’s affecting you so greatly. I can see that this is upsetting (08 occupational therapist late career)

I have a counsellor who works in my clinic so usually I will refer to her if I noticed any sort of distress in regards to recently finding out about the diagnosis or having difficulty living with it (13 chiropractor early career)

A lot of primary care practitioners have the electronic medical record which have a lot of flow sheets [with] a lot of guidance documents in there… So if there are some concerns [with mental health], you can walk them through the flow sheet of what it is that you need to get addressed (19 healthcare executive late career)

The OA tool under non-pharmacological self-management refers to mental health counsellor if available (15 policymaker quality-improvement late career)

Manage uncertainty

Acknowledge uncertainty, offer encouragement, provide advice to prevent or delay worsening, and manage symptoms

She told me that since is a mild case, you got to look after yourself, and when you have any pain, use these medication or topical ointments (18 woman Indian age 69)

They talked about how it can get worse. They give me solutions like exercises or physiotherapy services about how I can manage it better instead of concentrating on how much worse it can get (07 woman African age 43)

Managing expectations of treatment is part of it because there’s no cure to it. When it comes to non-pharmaceutical things, it’s only gonna work as well as the person’s gonna engage into it…so, highlighting that active participation in their treatment is critical for best outcomes (17 family physician late career)

We usually tell people that OA is a mystery, we don’t have a crystal ball, we don’t know whether it’s going to affect a lot of their joints or maybe just one joint… Education is key…to being proactive in recognizing the symptoms and managing it with exercise or physio (25 pharmacist mid career)

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Share decisions

Describe merits of different options but allow patient to choose options they prefer

We talked about the various treatment options and the medications that I could choose and how I would adjust my lifestyle…He asked me about my preferences because I was willing to take medications and exercise but I refused the option of surgery (07 woman African age 43)

What I like is that they didn’t impose because it’s up to me to do what I want. They [asked] me if I’m into physical fitness and I told them no. They didn’t give negative feedback on that. They said, if you’re considering exercising that would be good for your health (10 woman Filipino age 48)

I do like telling patients that I’m here to help them understand osteoarthritis and the treatment options and hopefully understand some of the pros and cons of what’s available to them so that they can make an informed decision (06 occupational therapist mid career)

Any treatment is the patient’s decision. I can’t force anybody to do anything or take anything. And I never try. I use other patients as examples because I find that people respond to that if they know that somebody else did something and it helped (17 family physician late career)

I don’t know of what’s happening in practice but the policies that are being developed are patient- and family-centred, and there’s a greater push for healthcare providers to have a collaborative decision-making approach (14 government policymaker mid career)

Enable self-care

Provide advice or resources to support self-management

He gave me a prescription to get a brace and he recommended that I get physio if that was something that I was able to access out of pocket (03 woman Caribbean age 48)

If the pain is really severe [they said] I can take Tylenol or Advil. They said several regular exercises like 15-min walk everyday would be good (05 woman Filipino age 40)

I explain to them what the best practice recommendations are and I try to find ways to integrate it into whatever it is they do in their normal life; for example, there might be a Muslim woman who has to pray five times a day and she has to get down on her knees—try to integrate some sort of activity in that fashion (05 physiotherapist late career)

We try and give people some tools that they can adopt to feel that they have some control over their arthritis or some pretty diverse toolbox that they can draw on in certain situations…We have some physical paper resources, we have some places that we can refer them to if they’re wanting to really delve into more some guided programs, a variety of some websites or hand-outs or us one-on-one guidance (06 occupational therapist mid career)

We also send every patient away, surgical or not, with a guide that we call “Living your Best Life with OA” It has general education about what OA is and it has managing OA (30 executive healthcare late career)

We do these small group “Ask Anything” sessions for people who have come to at least one education session and maybe just want to know a bit about surgery. They want to know a bit about injections. They want to know a little bit about other options for them (24 executive late career)