# Factors that influence the delivery of chiropractic services to equity-deserving groups in Canada: a qualitative study

## TL;DR

This study explores how Canadian chiropractors deliver care to marginalized groups and identifies factors that influence equitable service delivery.

## Contribution

The study provides new insights into institutional and individual barriers and strategies for improving cultural competency in chiropractic care.

## Key findings

- Institutions play a key role in advancing cultural competency through DEI strategies and training.
- Culturally responsive practices require clinicians to be aware of and sensitive to patients' cultural values.
- Access to care is influenced by socioeconomic and contextual factors that must be addressed for equity.

## Abstract

Health inequities disproportionately impact equity-deserving groups, which include individuals marginalized due to race, ethnicity, Indigenous identity, sex and gender, socioeconomic status, and other social determinants of health. This qualitative study aimed to explore Canadian chiropractors’ experiences and perceptions in delivering care to equity-deserving groups and identify individual and institutional factors that may influence care delivery.

We utilized interpretive description for data development, sampling, collection, and analysis. Participants were recruited as part of a larger mixed-methods research study, where we conducted a cross-sectional survey assessing Canadian chiropractors' diversity and cultural competency. We used maximum variation sampling to recruit chiropractors who indicated their interest in participating in the qualitative study.

Fourteen participants (N = 7, female) were included in this study, ranging from 28–64 years of age. We identified three major themes: 1) Perceived role of institutions to advance cultural competency, describing the approaches and strategies of professional associations and educational institutions in making changes concerning diversity, equity, and inclusion (DEI), 2) Fostering a culturally responsive clinical practice, describing factors that impact the delivery of care to equity-deserving groups (e.g. ensuring clinicians’ cultural awareness and sensitivity, promoting culturally competent behaviours, and understanding patients’ cultural values), and 3) Understanding the contextual determinants in accessing care (e.g., socioeconomic status, lack of accessibility, patient advocacy).

The results suggest that culturally congruent care involves top-down and bottom-up approaches that integrate DEI practices at institutional and clinician levels. Specifically, the incorporation of DEI training within curricula, the development of policies that foster diversity, the engagement of equity-deserving groups to understand unique cultural needs, and tailoring treatments to each patient rather than a one-size-fits-all approach.