School of Health Policy and Management

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Browsing School of Health Policy and Management by Author "Angus, JE"

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    Beyond barriers in studying disparities in women's access to health services in Ontario, Canada: a qualitative metasynthesis
    (SAGE, 2013-04) Angus, JE; Lombardo, AP; Lowndes, RH; Cechetto, N; Ahmad, F; Bierman, AS
    Women live within complex and differing social, economic, and environmental circumstances that influence options to seek health care. In this article we report on a metasynthesis of qualitative research concerning access disparities for women in the Canadian province of Ontario, where there is a publicly funded health care system. We took a metastudy approach to analysis of results from 35 relevant qualitative articles to understand the conditions and conceptualizations of women’s inequitable access to health care. The articles’ authors attributed access disparities to myriad barriers. We focused our analysis on these barriers to understand the contributing social and political forces. We found that four major, sometimes countervailing, forces shaped access to health care: (a) contextual conditions, (b) constraints, (c) barriers, and (d) deterrents. Complex convergences of these forces acted to push, pull, obstruct, and/or repel women as they sought health care, resulting in different patterns of inequitable access.
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    Exploring ways to overcome barriers to mammography uptake and retention among South Asian immigrant women
    (Wiley, 2013-01) Ahmad, F; Jandu, B; Albagli, A; Angus, JE; Ginsburg, O
    South Asians comprise one of the fastest growing immigrant groups in North America. Evidence indicates that South Asian (SA) immigrant women are vulnerable to low rates of breast cancer screening. Yet, there is a dearth of knowledge pertaining to socio-culturally tailored strategies to guide the uptake of screening mammography in the SA community. In 2010, the authors conducted semi-structured focus groups to elicit perspectives of health and social service professionals on possible solutions to barriers identified by SA immigrant women in a recent study conducted in the Greater Toronto Area. Thirty-five health and social services staff members participated in five focus groups. The discussions were audio taped and detailed field notes were taken. All collected data was transcribed verbatim and thematic analysis was conducted using techniques of constant comparison within and across the group discussions. Three dominant themes were identified: 1) “Target and Tailor” focused on awareness-raising through multiple direct and indirect modes or approaches with underlying shared processes of involving men and the whole family, use of first language, and learning from peers; 2) “Enhancing Access to Services” included a focus on ‘adding ancillary services’ and ‘reinforcement of existing services’ including expansion to a one-stop model; and 3) “Meta-Characteristics” centred on providing ‘multi-pronged’ approaches to reach the community, and ‘sustainability’ of initiatives by addressing structural barriers of adequate funding, healthcare provider mix, inter-sectoral collaboration, and community voice. The findings simultaneously shed light on the grass-roots practical strategies and the system level changes in order to develop efficient programmes for the uptake of mammography among SA immigrant women. The parallel focus on the “Target and Tailor” and “Enhancing Access to Services” calls for coordination at the policy level so that multiple sectors work jointly to streamline resources, or meta-characteristics.
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    Women’s strategies to achieve access to healthcare in Ontario, Canada: a meta-synthesis
    (Wiley, 2014-03) Lombardo, AP; Angus, JE; Lowndes, R; Cechetto, N; Khattak, S; Ahmad, F; Bierman, AS
    As part of a mixed methods study on women’s access to the healthcare system in Ontario, Canada, we undertook a qualitative meta-synthesis to better understand the contextual conditions under which women access healthcare. An earlier phase of the synthesis demonstrated a series of factors that complicate women’s access to healthcare in Ontario. Here, we consider women’s agency in responding to these factors. We used metastudy methods to synthesise findings from qualitative studies published between January 2002 and December 2010. Studies were identified by searches of numerous databases, including CINAHL, MEDLINE, Scopus, Gender Studies Database and LGBT Life. Inclusion criteria included use of a qualitative research design; published in a peer-reviewed journal during the specified time period; included a sample at least partially recruited in Ontario; included distinct findings for women participants; and in English language. Studies were included in the final sample after appraisals using a qualitative research appraisal tool. We found that women utilised a spectrum of responses to forces limiting access to healthcare: mobilising financial, social and interpersonal resources; living out shortfalls by making do, doing without, and emotional self-management; and avoiding illness and maintaining health. Across the studies, women described their efforts to overcome challenges to accessing healthcare. However, there were evident limits to women’s agency and many of their strategies represented temporary measures rather than viable long-term solutions. While women can be resourceful and resilient in overcoming access disparities, systemic problems still need to be addressed. Women need to be involved in designing and implementing interventions to improve access to healthcare, and to address the root problems of these issues.

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