Table 5 Key informant views about strategies to improve equitable timely person-centred OA care for diverse women

Patient Level

    Offer education sessions about OA and self-management (women-only, group, in-person and virtual, multiple languages, across Canada, free, community centres)

We should have community awareness workshops or information sessions about arthritis (20 woman Pakistani age 44)

What would be wonderful to see is if group classes were offered in every province in different languages and to be small enough that… it can be tailored a little bit but not so small that we don’t service a lot of people at the same time (08 occupational therapist late career)

More education and information available out in the community. In churches or places of worship or places where they go to socialize (21 policymaker quality-improvement late career)

    Offer educational material (brochures physicians can hand out, posters in community settings and online, in different languages, include culturally relevant information)

If there’s education material. Maybe a video or something like that in different languages that will be helpful, so that we have a better understanding. Maybe have a plan for what’s next like what would we expect let’s say in one year and 5 years or 10 years you know what should we be doing so it can help us cope with that better (17 woman Chinese age 66)

Patient tools in multiple languages that can at least give them an idea of the condition as well as medication…They should be available on one Canada-wide site (26 pharmacist mid career)

There definitely needs to be consideration for offering education materials in other languages (30 executive healthcare late career)

    Consider patients’ cultural needs and economic circumstances when offering treatment, or self-care advice and/or programs (language, interpreters, cost of services such as physiotherapy)

If the doctor would feel that the patient does not understand what he’s talking about, he should request for an interpreter or else the patient won’t understand what the doctor is talking about (05 woman Filipino age 40)

I do know that aquafit is one of our biggest recommendations with OA. But I don’t necessarily think aquafit is culturally sensitive. I feel like there must be other forms of exercise like dance or something that would be equally beneficial and that diverse women might embrace more (12 physiotherapist late career)

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    Offer peer support groups to help with self-care (virtual and in-person, multiple languages)

Peer-to-peer support. Women who are struggling with arthritis and have found ways to get around it can share that with women who are just starting to have issues (08 woman Caucasian age 70)

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    Regular follow up from doctors to monitor OA symptoms and self-care

When there is a lot of information to absorb and you’re working against cultural and language barriers, patients need to have more than one visit (19 woman Chinese age 46)

Often when you see your nurse practitioner or physician again, it’s the first point of diagnosis and you don’t really know what to ask yet…either nurses or someone else that can ask questions or intentionally do a meaningful follow up is important to probe, how are things going? What’s working well? Do you have questions? (23 nurse practitioner early career)

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Healthcare Professional Level

    Medical or continuing education on diagnosing and managing persons with OA

Maybe [doctors] need more education and training especially in arthritis. Because there is no treatment for arthritis and arthritis is very painful and it is very common (27 woman Indian age not reported)

Maybe some sort of continuing education. I think webinars are a good way to go especially now. It seems like a lot of the continuing education that I’m doing is virtual these days (13 chiropractor early career)

Starting from curriculum development all the way to training current providers and on-going training and some sort of performance management system where they demonstrate that understanding and they’re applying it (14 government policymaker mid career)

    Education or training on providing person-centred OA care tailored for diverse persons

[Healthcare providers] should have cultural awareness training for them to understand different cultures especially for women (12 woman Filipino age 54)

Cultural training about different areas of the world and different… cultural or belief or approaches to different things (07 physiotherapist late career)

Educating the staff and people who come to access care to understand their needs better and provide the care from a very culturally appropriate place (14 government policymaker mid career)

    Access to interpreters

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I haven’t really found [help] for people who may not speak English… we have a lot of people who have immigrated from the Philippines, from India… I don’t really know anyone who speaks those languages (16 chiropractor early career)

If there is a language barrier, [there should be] some sort of interpretation services available to support the clinician and the patient so that they can communicate (21 policymaker quality-improvement late career)

    OA assessment tools

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Decision-making tools to say what’s your threshold if we’re referring to ortho, recommended initial assessment and follow up in 4 to 6 weeks or whatever, assess for falls risk if it’s a hip or a knee arthritis. All of us like things that are easy to follow and help provide consistent care (23 nurse practitioner early career)

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Healthcare System Level

    Public health campaign to raise awareness of how to prevent and manage OA (available in different languages)

The government can possibly have health promotional activities on osteoarthritis…help people understand the symptoms and how to better manage it. I feel that information can be useful (07 woman African age 43)

Having things in clinic like posters or hand-outs goes a long way even to get people to recognize that their symptoms might be [OA] and that this is something you should talk to your doctor about and there’s things that can help (17 family physician late career)

A public education campaign… why don’t we try and get a clear message that early osteoarthritis doesn’t equal knee replacement which many people do believe, and trying to change the thinking (22 executive research late career)

    Self-referral to therapy (for those without family physician)

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I wonder if the concept of self-referral to a clinic or to an educational program would be an option to help improve accessibility because if they don’t have a family doctor…that’s a significant barrier (25 pharmacist mid career)

There probably needs to be mechanism to access care without a primary care provider (30 executive healthcare late career)

    Dedicated inter-professional OA clinics

A specific arthritis clinic that you can go and have your questions answered or learn how to minimize your symptoms…including a physiotherapist, massage therapist, dietary, nutrition, exercise, kinesiology…it’s something I’m sure could be run by a nurse or nurse-practitioner (02 woman Caucasian age 72)

Our health care system is not set-up to be very accessible [for] clients on low income with no vehicle and limited access to public transportation. They’re faced with having appointments at all these different place. Could care be provided in more of a central, a one-stop? (06 occupational therapist mid career)

A lot of this kind of care…can be provided by other members of the team. Your nurse could do a lot of the counselling, if there’s medication, a pharmacist in-house could do a lot of the counselling related to that. Many teams have physiotherapists (19 healthcare executive late career)

    Increase number of healthcare professionals for OA

If the government can provide more doctors in the towns like us where we are overpopulated then it would be better (05 woman Filipino age 40)

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More primary care nurses, extended care nurses, nurse practitioners would be part of the solution. So people get knee pain and then they can talk to a nurse (22 executive research late career)

    Increase diversity among healthcare professionals (gender, ethnicity)

More women nurses should be available just to increase the ability for expressing one-self from women to women (15 woman African age 45)

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We need more diverse healthcare providers, physicians, nurses… even at the policy-level we need a more diverse representation (14 government policymaker mid career)

    Publicly fund therapists

If they want to give relief for people suffering with arthritis we have to get free access to our physiotherapies (25 woman Pakistani age 60)

Having better health coverage for the people who are gonna work directly with the OA. A lot of the diverse women that I deal with are either recent immigrants or from lower socio-economic status and [not] having to worry about the financial burden of dealing with their health would make a big difference on them actually continuing with their treatment plans (03 chiropractor early career)

People will have different access to various supports. So trying to make sure we get that high quality care to everybody (31 executive charity late career)

    Expand scope of practice of therapists, pharmacists

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With some training and with presence of some more medical directives, we could streamline the patient into the right channel much better than what we are doing now… like blood work, for example, all my patients who present to me with some inflammatory presentations; if I’m able to send them for tests (04 physiotherapist late career)

Just give our therapist the autonomy to see who’s in front of them and if it is somebody who requires an extra visit or requires something that’s not part of necessarily a standard protocol that we do offer them the ability to do that (29 executive charity late career)

    Develop healthcare policy to address the needs of diverse women

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Prioritizing care for both women and diverse women. Recognizing that these patients may require more resources and or different types of resources and or the providers may need more training and sometimes even more time allocated for the assessments. I think it is just that recognition that these are patients in the system that aren’t getting equitable care (12 physiotherapist late career)

There needs to be an overarching equity and diversity and inclusion policy which also covers cultural competency, cultural appropriateness, cultural sensitivity and safety, which would then have more subsets of how to reach specific populations and specific healthcare settings (14 government policymaker mid career)

    National OA strategy and standardized pathway for OA care

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Canada and the provinces need a much better developed OA strategy and that has to cross from government level to primary care down to the first line clinicians… it needs to be a full drawn-out pathway for a client to follow (06 occupational therapist mid career)

There needs to be the digital and maybe physical infrastructure to support people getting the right tools, the right information, the right people. Some of it comes under funding but a lot of it comes down to coordination and getting all the different parts of the ecosystem to be connected (31 executive charity late career)