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Health Care Reform Serving Diversity Unpaid Caregiving Midwifery
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An Exploration of Women-Centred Care in the Context of Cervical Cancer Screening in Ethnocultural Groups Joan L. Bottorff, School of Nursing, University of British Columbia, Lynda G. Balneaves, School of Nursing, University of British Columbia, Lorna Sent, Family Physician and former Medical Director of The Asian Women’s Health Clinic, Suki Grewal, Community Health Nurse, Vancouver/Richmond Health Board, Annette J. Browne, University of Northern British Columbia and School of Nursing, University of British Columbia
Under-utilization of mainstream health services by women from ethnocultural minority groups has led to the development of specialized health services. These services provide an important focus for the study of women-centred care. The purpose of this study was to identify and describe critical elements of women-centred care within the context of three cervical cancer screening clinics in Vancouver that serve Asian, South Asian, and First Nations women. A further aim of the study was to identify the factors that influenced full implementation of women-centred care within these clinics. A collective case study design was used, with each of the three clinics treated as a separate case. The clinics serving Asian and South Asian women began as community-based initiatives and offered a limited number of evening appointments with services provided by women from the two ethnic communities. Because of challenges encountered in drawing women to the clinic, The First Nations Pap Test Clinic, a timelimited demonstration project developed by researchers and a community advisory committee, was not in operation at the time of the study but was included for comparative purposes. Data were drawn from open-ended interviews with key informants from each clinic and with women from the Asian and South Asian communities. Women who had received services from the First Nations Pap Test Clinic while it was in operation were not included because of the time that had lapsed since the clinic’s closure, but some of the people involved in the organization of the clinic were interviewed. A total of 35 women and 14 key informants participated in the study. Following thematic analysis, cross-case analysis was completed by comparing and contrasting issues and contextual factors influencing women’s and providers’ experiences. The clinics’ cervical screening services were characterized by attention to ethnocultural values, women’s desire for thorough explanations, and the importance of a comfortable setting. While participation rates varied across clinics, women were positive about their experiences in obtaining cervical screening at the specialized clinics. Some women’s expectations that they could address a range of health concerns with female health providers at the clinics were stymied by structural barriers that prevented staff from addressing issues beyond those directly related to cervical screening. Cross-case analysis revealed three key elements of womencentred care: respectful and culturally appropriate interactions between women and health providers; the importance of providing acceptable alternatives for women; and the need for comprehensive health services. Full embodiment of these components within the context of cervical screening was hampered by structures in the health care system. For example, we found that a woman’s choice about which health care professional—a doctor, nurse practitioner or nurse—provides Pap testing services is limited by the fee-for-service model of reimbursement. This model does little to address women’s preferences for female providers or to acknowledge the social context of women’s health care concerns. Evidence from this study shows that women were attracted to the Pap test clinics because they expected to be able to discuss health care concerns with a female health care provider. We recommend, therefore, that the mandates of the clinics be revisited. Policies that support comprehensive women’s health services that encompass, rather than segregate, cancer screening are required. Other models for providing health care to women in ethnocultural minority groups, including the use of clinics staffed by nurse practitioners, should be evaluated. Funding criteria should accommodate specialized services, as well as provide for complementary language services. For a full copy of the report contact: |
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