University of British Columbia Vancouver, BC, Canada
Megan Thomas1, Cheryl Barnabe2, Tessa Kleissen2, Diane Lacaille3, Glen Hazlewood2, Nejat Hassen4, Richard Henry5, Kelly English6, Michael Kuluva7, Aurore Fifi-Mah2 and Nicole Johnson2, 1University of British Columbia, Vancouver, BC, Canada, 2University of Calgary, Calgary, AB, Canada, 3Arthritis Research Canada, University of British Columbia, Vancouver, BC, Canada, 4University of British Columbia, Arthritis Research Canada, RICHMOND, BC, Canada, 5McGill University, Montréal, QC, Canada, 6Arthritis Patient Advisory Board of Arthritis Research Canada, Vancouver, BC, Canada, 7Creaky Joints, Vancouver, BC, Canada
Background/Purpose: Guidelines may unintentionally introduce inequities in care through recommendations that do not reflect the realities of healthcare access and quality for persons who are marginalized in society. To inform future rheumatology guidelines that uphold equity for Black people living in Canada, we conducted semi-structured interviews to understand experiences related to rheumatoid arthritis (RA) care and suggested service-level strategies for reducing and mitigating inequities.
Methods: Interviews were conducted with individuals who identify as Black, live in Canada, and have a diagnosis of RA; they were recruited using purposive and snowball sampling. Three overarching questions were explored with participants: i) population factors relevant to RA care; ii) initial and ongoing access to healthcare services; and iii) medication access and treatment strategy. Interviews were conducted via Zoom and audio-recordings were transcribed. A thematic analysis using the Braun and Clarke method with a deductive coding approach, using Critical Race Theory and a racial equity lens to guide analysis.
Results: Participants (n=6; 4 females and 2 males) expressed how their racial identity as a Black person contributed to their understanding of RA and their preferences for treatment and outcome goals. They shared how healthcare access is influenced by financial resource limitations and racism, exclusion and discrimination, but also by cultural norms in seeking healthcare and lack of knowledge about RA within the Black community. These limitations were exacerbated by intersectionality between race, sex, and gender, particularly when it came to stereotypes around pain tolerance expectations, and experiences of implicit bias. Participants stated that they experience health system fragmentation and are not supported in seeking ancillary supports. Financial barriers to medication access are encountered, with decision making about treatment influenced by the legacy of oppression and medical experimentation on Black people, and the predominance of biomedical approaches emphasized by healthcare providers. Participants indicated that RA care needs to shift to include and promote holistic and cultural approaches, provided in safe and trauma-informed care environments, and with flexibility in service models to accommodate persons facing financial barriers. Partnerships between arthritis care services and Black community organizations would increase community awareness and knowledge about arthritis, provide mechanisms of support for patients within their community, and serve to empower patients.
Conclusion: Arthritis care providers need to consider unique experiences of arthritis care based on race and ethnicity. Identified barriers to care must be addressed, while high quality, culturally relevant, and safe care must be facilitated through recommendations in treatment guidelines to achieve optimal arthritis outcomes of Black patients with RA in Canada.
Disclosures: M. Thomas, None; C. Barnabe, Janssen, Fresenius Kabi, Celltrion Healthcare, Pfizer; T. Kleissen, None; D. Lacaille, None; G. Hazlewood, None; N. Hassen, None; R. Henry, None; K. English, None; M. Kuluva, None; A. Fifi-Mah, Eli lilly, Pfizer, Janssen, BMS; N. Johnson, None.
