Qualitative analysis of responses to the ‘Care for Diverse Populations’ section of the 2019 Canadian Abortion Provider Survey
| Theme | Subtheme | Sample quotation |
| Adjusting care to patient’s religion and/or culture | – | “We serve an Indigenous population in Quebec and they occasionally request to take the fetal tissue home to bury which we will accommodate.” ‘Openness to particular requests around management of the products of conception; for the most part it’s just openness to any cultural/religious/etc. preferences or practices the patient may bring up.” |
| Including culturally appropriate support people on the team | “Involvement of culturally appropriate support people (eg, Indigenous cultural navigator/Indigenous midwife), faith-based supports (priest, imam), provision of CuddleCot so that family can take baby home.” “I always ensure I take the family situation into consideration as well as ensure that I'm able to ask about who their supports are. In some cases, family are unhelpful due to their religious beliefs and therefore I determine whether there are alternative supports for them.” | |
| Adjusting language and communication | – | “We care for a lot of international students in town for school - I find they often have very minimal understanding of contraceptive options so we have to take a lot of time to explain this to this population of patients. Sometimes a telephone translation service, or family member translating, is required for others.” “I adjust amount and speed of information-sharing based on comprehension, language, education, cognitive status, mental health, expression of cultural ethical concerns.” “Some patients request I use different terminology (ie, not refer to their situation as a ‘pregnancy’ or avoid the term ‘fetus/baby’) for personal reasons.” “Using different documents/handouts (languages, pictographs, etc.).” |
| Providing gender-affirmative, trauma-informed care | “Always using gender-neutral language, trans-inclusive assessment of services.” “Different terms to describe procedure/anatomy/contraception, use of preferred pronouns.” “I think we try to use trauma-informed care. We have moved away from using words like relax and trying to let individuals drive their medication choices.” “I discuss intimate partner violence and review how their partner feels/if they know and discuss safety if needed.” | |
| Shifting where and when services are provided | To make care more accessible | “I have some patients who live far away, so I adjust to more telephone follow-up and don't necessarily check serial hCG for those patients.” “I work with nurses in remote First Nations communities via telehealth to increase access to abortion care.” “…allow drop-ins and seeing people when they arrive, even if it’s late/the wrong appointment day/time.” “…may give them the option of taking medications in hospital versus at home if they live out in the communities that are far from the ER or have poor pain tolerance and require further care.” |
| To ensure communication and adherence | “For those with lower literacy or English language skills, I will definitely have them take the mifepristone on site. Sometimes, if I'm uncertain of their comprehension, I will have them take the misoprostol on site as well. I also follow them more closely with phone calls afterwards to ensure follow-up hCGs are done. I have created picture-rich infographics to facilitate understanding of the process.” “I have a primarily First Nations patient base from fly-in communities. I do multiple in-person visits to ensure communication is clear and ensure medication is taken correctly as many of my patients have limited medical literacy. Our policy requires them to be near a hospital rather than returning to fly-in communities so we see them and do ultrasounds earlier to try to confirm they are safe to fly home prior to discharge.” | |
| Asking patients to share their preferences | “I ask about patient preferences, beliefs, so I can present all options and ensure the options they know are available are consistent with their belief systems.” “Primarily, acknowledging the differences and asking the person to please feel comfortable correcting us if we make an error, and also asking them if there is anything we can do to make the situation more comfortable for them.” “…abortion care for me is part of primary healthcare delivery, which by nature is client-specific and tailored to each individual’s circumstances.” |
ER, emergency room; hCG, human chorionic gonadotropin.