Providing appropriate rheumatoid arthritis care to First Nations populations
Scientific Study Title:
Indigenous Patient Preferences for Rheumatoid Arthritis Pharmacotherapy
Study Start Date:
2015
Study End Date:
2017
Why did we do this research?
Treatment of rheumatoid arthritis (RA) with evidence-based therapies can prevent joint damage and disability. However, previous research has revealed that lower rates of evidence based-RA therapies are being used among Indigenous people, despite the disease being more severe in this population. Specifically in Alberta, Canada, Indigenous people are more likely to be diagnosed with RA, than the non-Indigenous people, and are less likely to get the specialized medical care they need for this condition. In order to understand the reasons for this gap in practice, we must understand the underlying reasons. We also believe that knowledge about Canadian indigenous peoples’ preferences for RA management is important.
Our objective was to find out Indigenous peoples’ preferences for managing their RA. This included understanding if they are open to using Western medicines, like disease-modifying antirheumatic drugs (DMARDS), which are known to prevent joint damage. This research was critical to ensure the needs of Indigenous patients are addressed to help eliminate gaps in health care.
What did we do?
Indigenous people from rural and urban southern Alberta communities including First Nations, Metis, and Inuit populations diagnosed with RA were invited to participate in interviews. This provided an in-depth understanding of their preferences and experiences with accessing healthcare.
What did we find?
Indigenous people with RA preferred to use a combination of non-pharmacologic (e.g., non-drug related) and pharmacologic (e.g., drug or medication-based) treatments to manage their RA. The non-drug treatments involved physical, mental, emotional, and spiritual approaches. When it came to taking medications, patients had different preferences. Their choices were influenced by clinical factors, such as: their trust in the healthcare providers; and, their understanding of how the drugs work, (benefits, potential side effects, and how easy they were to take). Family support and societal factors, such as access to medications and concerns about being dependent on drugs, also played a role in their decisions.
Communication is the foundation of healthcare. Moving forward, healthcare providers should work hard to help Indigenous patients better understand the effects of RA medications, while also understanding the societal and familial influences of patients’ decisions. Building a strong patient-provider relationship based on trust is also crucial. This can be achieved by healthcare models that prioritize cultural sensitivity, empathy, compassion, openness, acknowledgment, and respect for cultural differences.
Who funded this research?
Arthritis Research Canada funded this project.
The Research Team:
Principal Investigators:
Cheryl Barnabe, MD, FRCPC, Research Scientist, Arthritis Research Canada (University of Calgary)
Glen Hazlewood, MD, PhD, FRCPC, Research Scientist, Arthritis Research Canada (University of Calgary)
Co-Investigators:
Adalberto Loyola-Sanchez, PhD, (Supervisor: Cheryl Barnabe) former Postdoctoral Trainee, Arthritis Research Canada (University of Calgary)
Lynden Crowshoe, PhD, (University of Calgary)
Deborah Marshall, PhD, Research Scientist, Arthritis Research Canada (University of Calgary)
Tessa Linkert, (University of Calgary)
Pauline M. Hull (University of Calgary)
Related Publication:
Loyola-Sanchez, A., Hazlewood, G., Crowshoe, L., Linkert, T., Hull, P. M., Marshall, D., & Barnabe, C. (2020). Qualitative Study of Treatment Preferences for Rheumatoid Arthritis and Pharmacotherapy Acceptance: Indigenous Patient Perspectives. Arthritis care & research, 72(4), 544–552. https://doi.org/10.1002/acr.23869
