J. Roberts, M. Falk, South Eastman Health/Santé Sud-Est Inc.
As the health system gains a better understanding of the social dynamics of
health and health care, there is greater recognition that health planning has
much to gain from seeking input from women. As principal family caregivers and
high users of health care, women have frequent and intimate contact with the
health system. Furthermore, women as a population group are vulnerable; they are
disproportionately affected by many social factors - such as poverty and
violence - that put them at risk for ill health and bear a high burden of
health problems linked to reproduction, mental health, family violence, and
aging. The purpose of the study, therefore, was to seek guidance from women,
based on their knowledge, opinions, and life experiences, to shape planning for
women's health and health services within Manitoba's rural South Eastman
regional health authority (RHA).
To give voice to South Eastman women, the RHA partnered with a number of
local women's groups to conduct a community-wide qualitative study. Between
October 2000 and March 2001, 173 South Eastman women ages 19 to 85 years took
part in a series of personal interviews (5), focus groups (21), and discussion
groups (5) held in various communities throughout the region. Participants
represented a wide range of backgrounds and viewpoints, including communities of
women with special perspectives on health and health care, such as young adult
women, senior women, francophone women, women with disabilities, immigrant
women, women with experience of the mental health system, women with experience
of domestic violence, and farm women.
Interviews, focus groups, and discussion groups explored women's health by
soliciting participants' responses to three questions:
- What are the main women's health issues in your community?
- What barriers are there in your community that stand in the way of women's
health and health care?
- How can South Eastman regional health authority best work with your
community to improve women's health?
Women spoke from their own life experiences about health and interactions
with the health care system, contributing their knowledge, opinions, personal
stories, and recommendations. Each interview, focus group, and discussion group
was tape recorded. The tapes were subsequently transcribed verbatim and
analyzed, using standard qualitative research techniques, to delineate
consistent themes. Every effort made in the presentation of the findings to
describe participants' contributions in their own words.
Throughout the discussions, women made it clear that they consider health a
priority item, that they see themselves in the traditional family
caregiver/health manager roles, and that barriers to health and health care were
the key issues they wanted to discuss. With remarkable consistency across all
communities of women, participants identified a range of social and system
factors that stand in the way of health and health care, limiting women's
ability to take responsibility for their personal health and that of their
families, to interact positively with the health system, and to gain access to
necessary services. Despite women's diversity of backgrounds and experiences,
there was agreement across all groups regarding fundamental needs for greater
respect, for more accessible, holistic services, for better communications with
health care providers, and for information and assistance finding the mutual
support and services women need to deal with health problems. Women were also
agreed on recommendations to the regional health authority for ways to work with
communities to improve women's health, calling for a focus on women's
health, greater access to quality information on women's health concerns,
community advocacy, and systems to foster mutual support.
Acknowledging gender as a determinant of health
- Incorporate gender-based analysis as a routine component of
decision-making. This means not only ensuring that data for
evidence-based decision-making are collected and analyzed in sex-disaggregated
form, where available, but examining policy and planning decisions, where
appropriate, with an appreciation of gender variations to assess the potential
for differential impacts on women and men.
- Promote awareness and education on the role of gender in determining health.
Awareness and education should be targeted both to the public and to health
personnel, at all levels within the system. Teaching should relate to the social
dynamics of gender and to differential impacts on risks to health and responses
to prevention and intervention. A holistic approach should be taken, considering
health in the life context rather than focusing on specific diseases and
Acknowledging gender as a determinant of health services
- Strengthen the processes that women value. Women place particular value on
key processes that enhance access to health and health services, namely
taking individual responsibility for health, communicating successfully with
health staff, and gaining entry to the health system and access to necessary
services. Education and resources are required to help women develop and
enhance skills around these processes and to equip staff with the
appropriate knowledge and tools to give meaningful support to all health
- Acknowledge women's priorities. This means respecting women's
collective wisdom and life experiences and acting on their priorities and
suggestions. Policy-making and planning should build on women's
recommendations by working with communities to facilitate networking, mutual
support systems, and advocacy mechanisms for women's health and health
issues, as well as fostering effective communication and information
exchange between health providers and consumers.
- Involve consumers in health planning. Consumer participation in planning
should be part of the health system's quality management process. This
means involving consumers at various stages of program and service planning,
including needs assessment, design, implementation, and evaluation. The
approach enables the health system to benefit from consumer knowledge and
experience in identifying and meeting community health needs, monitoring the
appropriateness of services, assessing policy and planning decisions from
key perspectives, including that of gender, and measuring effects in terms
of health outcomes and consumer satisfaction.
- Promote and support gender-oriented health services research. There is
very little information available to guide the health system in
understanding the impacts of gender on health services, the interactions
between gender and other determinants, and the effectiveness of
interventions directed to improving health among men and women. In addition,
each organization responsible for health service delivery is unique in terms
of its structure and composition and the characteristics of the population
served. Gender-oriented research should therefore be priorized as a basic
prerequisite to planning health services for women and for men, keeping in
mind that population-specific research provides the best guide to
- Promote awareness and education on the role of gender in determining
health services. Awareness and education should be targeted to the public
and to health personnel at all levels throughout the system. Teaching should
relate to the ways in which gender can impact both the delivery and receipt
of health services, focusing on health behaviours, effective and sensitive
communication, power relations, and the impacts of personal values and
belief systems on interactions in health settings. Tools and resources
should be developed to assist in the educational process.
Recognizing Population Diversity
Addressing System Problems
- Maintain a population-based, evidence-based approach to health
policy-making and planning. This approach, by taking into account
population diversity with respect to life circumstances and life
experiences, enables the tailoring of health services to address the very
wide range of health and health care needs within gender groups.
- Examine enhanced and alternative methods of service provision. The effectiveness
and quality of local programs and services should be subject to review
incorporating consumer perspectives, and the cost-effectiveness of
enhanced/alternative service models explored.
The willingness of South Eastman women to contribute time and effort to this
project and their generosity in openly sharing experiences and insights on
health is gratefully acknowledged. The wealth of information collected with
their assistance offers valuable direction for the health of South Eastman
women, families, and communities.
Thanks are also extended to the Prairie Women's Health Centre of Excellence
(PWHCE) for the grant which made this research possible, to members of the
research team, and to regional and allied staff who assisted with the focus and
discussion group components and contributed helpful suggestions on earlier
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