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Williams KKA, Baidoobonso S, Haggerty J, Lofters A, Adams AM. Anti-Black discrimination in primary health care: a qualitative study exploring internalized racism in a Canadian context. Ethn Health 2024; 29:343-352. [PMID: 38332736 DOI: 10.1080/13557858.2024.2311429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES A growing body of evidence points to persistent health inequities within racialized minority communities, and the effects of racial discrimination on health outcomes and health care experiences. While much work has considered how anti-Black racism operates at the interpersonal and institutional levels, limited attention has focused on internalized racism and its consequences for health care. This study explores patients' attitudes towards anti-Black racism in a Canadian health care system, with a particular focus on internalized racism in primary health care. DESIGN This qualitative study employed purposive maximal variation and snowball sampling to recruit and interview self-identified Black persons aged 18 years and older who: (1) lived in Montréal during the COVID-19 pandemic, (2) could speak English or French, and (3) were registered with the Québec health insurance program. Adopting a phenomenological approach, in-depth interviews took place from October 2021 to July 2022. Following transcription, data were analyzed thematically. RESULTS Thirty-two participants were interviewed spanning an age range from 22 years to 79 years (mean: 42 years). Fifty-nine percent of the sample identified as women, 38% identified as men, and 3% identified as non-binary. Diversity was also reflected in terms of immigration experience, financial situation, and educational attainment. We identified three major themes that describe mechanisms through which internalized racism may manifest in health care to impact experiences: (1) the internalization of anti-Black racism by Black providers and patients, (2) the expression of anti-Black prejudice and discrimination by non-Black racialized minority providers, and (3) an insensitivity towards racial discrimination. CONCLUSION Our study suggests that multiple levels of racism, including internalized racism, must be addressed in efforts to promote health and health care equity among racialized minority groups, and particularly within Black communities.
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Affiliation(s)
| | - Shamara Baidoobonso
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Aisha Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Alayne M Adams
- Department of Family Medicine, McGill University, Montréal, Canada
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Adams AM, Williams KKA, Langill JC, Arsenault M, Leblanc I, Munro K, Haggerty J. Telemedicine perceptions and experiences of socially vulnerable households during the early stages of the COVID-19 pandemic: a qualitative study. CMAJ Open 2023; 11:E219-E226. [PMID: 36882210 PMCID: PMC10000894 DOI: 10.9778/cmajo.20220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Early in the COVID-19 pandemic, efforts to decrease risk of viral transmission triggered an abrupt shift from ambulatory health care delivery toward telemedicine. In this study, we explore the perceptions and experiences of telemedicine among socially vulnerable households and suggest strategies to increase equity in telemedicine access. METHODS Conducted between August 2020 and February 2021, this exploratory qualitative study involved in-depth interviews with members of socially vulnerable households needing health care. Participants were recruited from a food bank and primary care practice in Montréal. Digitally recorded telephone interviews focused on experiences and perceptions related to telemedicine access and use. In our thematic analysis, we employed the framework method to facilitate comparison, and the identification of patterns and themes. RESULTS Twenty-nine participants were interviewed, 48% of whom presented as women. Almost all sought health care in the early stages of the pandemic, 69% of which was received via telemedicine. Four themes emerged from the analysis: delays in seeking health care owing to competing priorities and perceptions that COVID-19-related health care took precedence; challenges with appointment booking and logistics given complex online systems, administrative inefficiencies, long wait times and missed calls; issues around quality and continuity of care; and conditional acceptance of telemedicine for certain health problems, and in exceptional circumstances. INTERPRETATION Early in the pandemic, participants report telemedicine delivery did not accommodate the diverse needs and capacities of socially vulnerable populations. Patient education, logistical support and care delivery by a trusted provider are suggested solutions, in addition to policies supporting digital equity and quality standards to promote telemedicine access and appropriate use.
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Affiliation(s)
- Alayne M Adams
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que.
| | - Khandideh K A Williams
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
| | - Jennifer C Langill
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
| | - Mylene Arsenault
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
| | - Isabelle Leblanc
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
| | - Kimberly Munro
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
| | - Jeannie Haggerty
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
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