Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Study protocol

EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings

Authors: Annette J. Browne, Colleen Varcoe, Marilyn Ford-Gilboe, C. Nadine Wathen, on behalf of the EQUIP Research Team

Published in: International Journal for Equity in Health | Issue 1/2015

Login to get access

Abstract

Background

The primary health care (PHC) sector is increasingly relevant as a site for population health interventions, particularly in relation to marginalized groups, where the greatest gains in health status can be achieved. The purpose of this paper is to provide an overview of an innovative multi-component, organizational-level intervention designed to enhance the capacity of PHC clinics to provide equity-oriented care, particularly for marginalized populations. The intervention, known as EQUIP, is being implemented in Canada in four diverse PHC clinics serving populations who are impacted by structural inequities. These PHC clinics serve as case studies for the implementation and evaluation of the EQUIP intervention. We discuss the evidence and theory that provide the basis for the intervention, describe the intervention components, and discuss the methods used to evaluate the implementation and impact of the intervention in diverse contexts.

Design and methods

Research and theory related to equity-oriented care, and complexity theory, are central to the design of the EQUIP intervention. The intervention aims to enhance capacity for equity-oriented care at the staff level, and at the organizational level (i.e., policy and operations) and is novel in its dual focus on:
(a)
Staff education: using standardized educational models and integration strategies to enhance staff knowledge, attitudes and practices related to equity-oriented care in general, and cultural safety, and trauma- and violence-informed care in particular, and;
 
(b)
Organizational integration and tailoring: using a participatory approach, practice facilitation, and catalyst grants to foster shifts in organizational structures, practices and policies to enhance the capacity to deliver equity-oriented care, improve processes of care, and shift key client outcomes.
 
Using a mixed methods, multiple case-study design, we are examining the impact of the intervention in enhancing staff knowledge, attitudes and practices; improving processes of care; shifting organizational policies and structures; and improving selected client outcomes.

Discussion

The multiple case study design provides an ideal opportunity to study the contextual factors shaping the implementation, uptake and impact of our tailored intervention within diverse PHC settings. The EQUIP intervention illustrates the complexities involved in enhancing the PHC sector's capacity to provide equity-oriented care in real world clinical contexts.
Footnotes
1
PHC is conceptualized as the principal vehicle for the delivery of health care at the most local level of a country’s health system. Primary care is one of PHC’s core services because it serves as the first point of entry, provides person-focused care for all but the most uncommon conditions, and integrates or co-ordinates care provided elsewhere.
 
2
In this research program, the terms ‘marginalization’ or ‘marginalized’ refer to the social, political and economic conditions that create structural, social and health inequities in Canada and other nations, versus a characteristic that can be attributable to any particular population or group.
 
3
The Indigenous Cultural Competency (ICC) program was developed in British Columbia (BC), Canada, by the Aboriginal Health Division of the BC Provincial Health Services Authority (PHSA), and has been adapted for use in other provinces across Canada, and in Australia. Further information about this program can be found at: http://​www.​culturalcompeten​cy.​ca/​.
 
Literature
1.
World Health Organization. The World Health Report 2008 - primary health care (Now more than ever). Geneva, Switzerland: World Health Organization; 2008.
2.
Politzer RM, Schempf AH, Starfield B, Shi L. The future role of health centers in improving national health. J Public Health Policy. 2003;24(3/4):296–306.PubMedCrossRef
3.
4.
5.
6.
Nasmith L, Ballem P, Baxter R, Bergman H, Colin-Thomé D, Herbert C, et al. Transforming care for Canadians with chronic health conditions: Put people first, expect the best, manage for results. Ottawa, ON: Canadian Academy of Health Sciences; 2010.
7.
Allen M, Allen J, Hogarth S, Marmot M. Working for health equity: The role of health professionals. London, UK: UCL Institute of Health Equity; 2013.
8.
Browne AJ, Varcoe C, Wong ST, Smye VL, Lavoie JG, Littlejohn D, et al. Closing the health equity gap: Evidence-based strategies for primary health care organizations. Int J Equity Health. 2012;11(59):1–15. doi:10.​1186/​1475-9276-11-59.
9.
The Chief Public Health Officer. The Chief Public Health Officer’s report on the state of public health in Canada 2009. Growing up well - Priorities for a healthy future. Ottawa, ON: Public Health Agency of Canada; 2009.
10.
Raphael D. Poverty in Canada: Implications for health and quality of life. 2nd ed. Toronto, Canada: Canadian Scholars’ Press; 2011.
11.
Organisation for Economic Cooperation and Development. Focus on top incomes and taxation in OECD countries: Was the crisis a game changer? Organisation for Economic Cooperation and Development; 2014.
12.
13.
Farmer P. Reimagining equity. In: Weigel JL, editor. To repair the world: Paul Farmer speaks to the next generation. Berkeley and Los Angeles, CA: University of California Press; 2013. p. 2–6.
14.
15.
Braveman P. What are health disparities and health equity? We need to be clear. Public Health Rep. 2014;129 Suppl 2:5–8.PubMedPubMedCentral
16.
17.
Public Health Agency of Canada. Core competencies for public health in Canada: Release 1.0. Ottawa, ON: Public Health Agency of Canada; 2007.
18.
Browne AJ, Varcoe C, Fridkin A. Addressing trauma, violence and pain: Research on health services for women at the intersections of history and economics. In: Hankivsky O, editor. Health inequities in Canada: intersectional frameworks and practices. Vancouver: UBC Press; 2011. p. 295–311.
19.
Wong ST, Browne AJ, Varcoe C, Lavoie JG, Smye VL, Godwin O et al. Enhancing measurement of primary health care indicators using an equity lens: An ethnographic study. Int J Equity Health. 2011;10(38). doi:10.​1186/​1475-9276-10-38.
20.
Ford-Gilboe M, Varcoe C, Wuest J, Merritt-Gray M. Intimate partner violence and nursing practice. In: Humphreys J, Campbell J, editors. Family violence and nursing practice. 2nd ed. New York, NY: Springer Publishing; 2010. p. 115–54.
21.
Elliott DE, Bjelajac P, Fallot RD, Markoff LS, Reed BG. Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women. J Community Psychol. 2005;33(4):461–77. doi:10.​1002/​jcop.​20063.CrossRef
22.
Ford JD, Smith SF. Complex posttraumatic stress disorder in trauma-exposed adults receiving public sector outpatient substance abuse disorder treatment. Addict Res Theory. 2008;16(2):193–203. doi:10.​1080/​1606635070161507​8.CrossRef
23.
Campbell R, Greeson MR, Bybee D, Raja S. The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: A mediational model of posttraumatic stress disorder and physical health outcomes. J Consult Clin Psychol. 2008;76(2):194–207. doi:10.​1037/​0022-006X.​76.​2.​194.PubMedCrossRef
24.
Haskell L, Randall M. Disrupted attachments: A social context complex trauma framework and the lives of Aboriginal peoples in Canada. J Aborig Health. 2009;5(3):48–99.
25.
Covington SS, Burke C, Keaton S, Norcott C. Evaluation of a trauma-informed and gender-responsive intervention for women in drug treatment. J Psychoactive Drugs. 2008; November(Suppl 5):387–98. doi:10.​1080/​02791072.​2008.​10400666.
26.
Varcoe C, Hankivsky O, Ford-Gilboe M, Wuest J, Wilk P, Hammerton J, et al. Attributing selected costs to intimate partner violence in a sample of women who have left abusive partners: A social determinants of health approach. Canadian Public Policy. 2011;37(3):359–80. doi:10.​1353/​cpp.​2011.​0029.PubMedCrossRef
27.
28.
29.
Ford-Gilboe M, Wuest J, Varcoe C, Davies L, Merritt-Gray M, Campbell JC, et al. Modelling the effects of intimate partner violence and access to resources on women’s health in the early years after leaving an abusive partner. Soc Sci Med. 2009;68(6):1021–9. doi:10.​1016/​j.​socscimed.​2009.​01.​003.PubMedCrossRef
30.
Varcoe C. Inequality, violence and women’s health. In: Bolaria BS, Dickinson HD, editors. Health, illness and health care in Canada. 4th ed. Toronto, ON: Nelson; 2009. p. 259–82.
31.
Varcoe C, Dick S. The intersecting risks of violence and HIV for rural Aboriginal women in a neo-colonial Canadian context. J Aborig Health. 2008;4(1):42–52.
32.
33.
Varcoe C. Interpersonal violence assessment. In: Browne AJ, MacDonald-Jenkins J, Luctkar-Flude M, editors. Physical examination and health assessment by C. Jarvis. 2nd Canadian ed. Toronto, ON: Elsevier; 2014. p. 120–37.
34.
35.
Herbert E, McCannell K. Talking back: Six First Nations women’s stories of recovery from childhood sexual abuse and addictions. Can J Commun Ment Health. 1997;16(2):51–68.CrossRef
36.
Wathen CN, MacMillan HL, Ford-Gilboe M, Wekerle C, Jack SM, Sibbald SL. New knowledge about violence across the lifespan: Sharing the findings of three large research programs. Knowledge to Action: An End-of-Grant Knowledge Translation Casebook. Ottawa, ON: Canadian Institutes of Health Research; 2010. p. 29–32.
37.
38.
Ramsden I. Cultural safety and nursing education in Aotearoa and Te Waipounamu [Doctoral dissertation]. Wellington, New Zealand: University of Wellington; 2002.
39.
Ramsden I. Cultural safety/Kawa Whakaruruhau ten years on: A personal overview. Nurs Prax N Z. 2000;15(1):4–12.PubMed
40.
41.
42.
Varcoe C, Browne AJ. Culture and cultural safety: Beyond cultural inventories. In: Gregory D, Raymond-Seniuk C, Patrick L, Stephen TC, editors. Fundamentals: Perspectives on the art & science of Canadian nursing. Philadelphia: Lippincott Williams & Wilkins; 2014.
43.
44.
Anderson JM, Perry J, Blue C, Browne AJ, Henderson A, Khan KB, et al. “Rewriting” cultural safety within the postcolonial and postnational feminist project: Toward new epistemologies of healing. ANS Adv Nurs Sci. 2003;26(3):196–214.PubMedCrossRef
45.
46.
Pauly B, McCall J, Browne AJ, Mollison A, Parker J. Towards cultural safety: Nurse and patient constructions of illicit substance use in hospitalized settings. ANS Adv Nurs Sci. 2015;38(2):121–35.
47.
Health Council of Canada. Empathy, dignity, and respect: Creating cultural safety for aboriginal people in urban health care. Toronto, ON: Health Council of Canada; 2012.
48.
Aboriginal Nurses Association of Canada. Cultural competence and cultural safety in nursing education introduction. [Information Sheet]. Ottawa, ON: Aboriginal Nurses Association of Canada; 2010.
49.
Brascoupé S, Waters C. Cultural safety - Exploring the applicability of the concept of cultural safety to aboriginal health and community wellness. J Aborig Health. 2009;5(2):6–41.
50.
Indigenous Physicians Association of Canada, The Royal College of Physicians and Surgeons of Canada. Cultural safety in practice: A curriculum for family medicine residents and physicians. Winnipeg & Ottawa: IPAC-RCPSC Family Medicine Curriculum Development Working Group; 2009.
51.
Nursing Council of New Zealand. Guidelines for cultural safety, the treaty of Waitangi and Maori health in nursing education and practice. Wellington, New Zealand: Nursing Council of New Zealand; 2005.
52.
53.
Hawe P, Shiell A, Riley T. In response to Spillane V., Byrne M.C., Byrne M., Leathem C. S., O'Malley M. & Cupples M.E. (2007) Monitoring treatment fidelity in a randomized trial of a complex intervention. Journal of Advanced Nursing 60(3), 343–352. Important considerations for standardizing complex interventions. J Adv Nurs. 2008;62(2):267. doi:10.​1111/​j.​1365-2648.​2008.​04686.​x.
54.
55.
56.
57.
Craig P, Dieppe P, Macintyre S, Mitchie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: The new medical research council guidance. Br Med J. 2008;337(7676):979–83. doi:10.​1136/​bmj.​a1655.
58.
Hawe P, Riley T, Ghali L. Developing sustainable interventions: Theory and evidence. In: Herrman H, Saxena S, Moodie R, editors. Promoting mental health: concepts, emerging evidence, practice. Geneva: World Health Organization; 2005.
59.
Wathen CN, Tanaka M, Catallo C, Lebner AC, Friedman MK, Hanson MD et al. Are clinicians being prepared to care for abused women? A survey of health professional education in Ontario, Canada. BMC Med Educ. 2009;9(34). doi:10.​1186/​1472-6920-9-34.
60.
Davis D, O’Brien MAT, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999;282(9):867–74. doi:10.​1001/​jama.​282.​9.​867.PubMedCrossRef
61.
The Association of Faculties of Medicine of Canada. The Future of Medical Education in Canada (FMEC): A collective vision for MD education. Ottawa, ON: The Association of Faculties of Medicine of Canada; 2010.
62.
Poole N. Essentials of trauma-informed care. Ottawa, ON: The Canadian Network of Substance Abuse and Allied Professionals; 2012.
63.
Trauma-informed Practice Project Team. Trauma-informed practice guide. Vancouver, BC: BC Provincial Mental Health and Substance Use Planning Council; 2013.
64.
Stake RE. Qualitative case studies. In: Denzin NK, Lincoln YS, editors. The Sage handbook of qualitative research. 3rd ed. Thousand Oaks, CA: Sage Publications; 2005. p. 443–66.
65.
Stake RE. Multiple case study analysis. New York, NY: Guildford Press; 2006.
Metadata
Title
EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings
Authors
Annette J. Browne
Colleen Varcoe
Marilyn Ford-Gilboe
C. Nadine Wathen
on behalf of the EQUIP Research Team
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0271-y

Other articles of this Issue 1/2015

International Journal for Equity in Health 1/2015 Go to the issue

Study protocol

Care seeking pathways of older adults with hip fracture in India: exploratory study protocol

Research

Social determinants of health in the Mixtec and Zapotec community in Ventura County, California

Research Article

Urban-rural inequality regarding drug prescriptions in primary care facilities – a pre-post comparison of the National Essential Medicines Scheme of China

Research

Socioeconomic hierarchy and health gradient in Europe: the role of income inequality and of social origins

Research

Social inequalities in patient-reported outcomes among older multimorbid patients – results of the MultiCare cohort study

Research

Determinants of access to healthcare by older persons in Uganda: a cross-sectional study