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Wiklund M.1,2, Fjellman-Wiklund A.1, Stålnacke B.-M.1, Hammarström A.2, Lehti A.3
1Umeå University, Community Medicine and Rehabilitation, Umeå, Sweden, 2Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden, 3Umeå University, Clinical Sciences, Umeå, Sweden
Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. Gender bias is found in access, counselling, assessment, and treatment of long-term pain.
Purpose: This study explored patient accounts and perceptions about important factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic in northern Sweden.
Methods: Individual semi-structured interviews were conducted with 10 adults, women and men, after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients perceptions of important factors for accessing rehabilitation. Gender theory worked as a theoretical and conceptual frame.
Results: One main theme was formulated as Access to rehab not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). Generally, women were regarded as being less valued and holding a lower status in the healthcare system than men. The character of diagnosis received (medical versus psychiatric or social) was also noted. Receiving a diagnosis or explanation was important to participants in making sense of their pain. Taken together, different entrance tickets (related to social capital and habitus) were identified that worked together to enhance or hinder selection and access to rehabilitation resources. The consequences of an individual being regarded as an ideal patient (with access to specialty rehabilitation resources) or as a non-ideal patient (with access denied) were great. Outcomes were tangible for participants as they affected access to ways of coping with non-reversible pain, support, and the social health insurance system.
Conclusion(s): Our results point to patient perceptions of rehabilitation as a resource that is not equally available to everyone. Reduction of social determinants of health and biases remain important within global, national, and local contexts.
Implications: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Using a tool that addresses gender inequality, and intersecting social aspects, in daily clinical work may be one way of raising awareness.
Funding acknowledgements: Swedish Research Council (grant nos 344-2009-5839 and 344-2011-5478).
Topic: Pain & pain management
Ethics approval: The study was approved by the Regional Ethics Vetting Board in Umea° , Sweden (Dnr 2010-44-31).
All authors, affiliations and abstracts have been published as submitted.
