ON Chiropractic
Another early step to take is to look
at the structure of your practice, both in
terms of the space and how it is organized
and the staff you have available to patients.
Internal and external signage can be a clear
signal to your community that you are
making an effort to serve everyone. For
instance, if you are fortunate enough to
have the capacity to offer care in multiple
languages, try putting up a sign that
demonstrates that ability.
You may also consider recruiting staff
that is representative of your community.
There is a well-established principle
in community policing that supports
this practice. Known as the Theory
of Representativeness, the principle
is simple: the people that serve the
community should reflect the community.
At minimum, if you know there is a
significant minority in your community
that is likely to benefit from translation
services, find a local service that can
provide translation services for marketing
materials or live translation of patient
interactions. You may decide to absorb that
cost or pass it through to the patient.
These are all examples of potential
solutions to immediate structural barriers
to care for potential patients in your
community. Like most, the Ontario
health care system can be complex and
difficult to navigate for some patients. For
instance, a lack of fluency in English can
pose a serious barrier to care. Betancourt
et al reported that in the United States,
Spanish-speaking patients discharged
from emergency rooms are less likely than
English-speaking patients to understand
their diagnosis, prescribed medications,
special instructions and plans for followup care. Spanish-speaking patients were
also found to be less likely to be satisfied
with their care or willing to return if they
experience a problem in recovery.: By
addressing some of the structural barriers
in your community you will be taking an
important step towards serving the full
spectrum of potential patients in your
community.
Longer-Term Actions
D
eepening your understanding of
the cultural, ethnic, religious,
socioeconomic, age and gender
related differences you are likely to interact
with in practice is a good next step.
Depending on what you’ve discovered
about the diversity of your community,
this may be a very big job indeed. It
might make sense for you to prioritize
your research and learning based on the
current makeup of your patient roster, your
most common referral sources and the
predominant groups and subgroups in your
community.
Here are some aspects of patient
diversity to explore as you conduct your
researchb:
Degree of Acculturation
Newcomers to Canada will likely
display behaviours and practices more
closely aligned with the culture they were
born into. Over time, individuals tend to
acculturate by adopting, to varying degrees,
the cultures and behaviours of the new or
mainstream culture in which they now live.
Patients you encounter may be “highly
assimilated” and comfortable interacting
with you in the same way a patient born at
your local hospital to a multi-generation
Canadian family would. Others may
be most comfortable maintaining their
original culture and experience a very low
degree of acculturation.
Socioeconomic Status
It has been argued that socioeconomic
status, as determined by level of income,
level of education and occupation, is
“arguably the most relevant variable
affecting a person’s worldview and health
status.” Poverty is often strongly correlated
with ethnicity, gender and age.
Incidence and Prevalence of Disease
and Disability
Similar to socioeconomic status,
many studies have tracked and reported
disparities in the incidence and prevalence
of certain diseases and disabilities according
to ethnicity, gender and age.
Expectations Related to Aging and
Pain
If a patient expects to have more
pain and less mobility as they age, they
may be less likely to adhere to a treatment
plan and recover from pain. Other senior
p