Access to primary health care for racial minority women in Canada: Opportunities for social work and social justice to impact barriers and facilitators of effective health care

Despite the availability of universal health care in Canada, research suggests that racial minority women do not have equitable access to health care. This study explored factors that contribute to disparity in primary care access for racial minority women, identified opportunities for improving service access and piloted an access program. In Toronto, Canada, 226 women representing 4 ethnic groups (African, Caribbean, Latin American, South Asian), various social categorizations (homelessness, physical disability, HIV–positive status, lesbian/bisexual identity) and mostly immigrant and low-income were surveyed about access to health care. Survey items addressed service use, health care access barriers and facilitators of access. The most highly endorsed barriers to care were finances for travel, distance and/or hours of service, staffing concerns (gender, language, respect), and competing personal commitments. Participants reported that access was facilitated primarily by members of informal support networks, social workers and community-based nurses. Qualitative data suggested that social justice interventions were key to improving women's experiences in the health care system. The data were used to develop a model and pilot program that was delivered at a social service agency for 3 months. The program provided health care, anti-oppression training for service providers, rights education for clients and the services of a ‘navigator' to facilitate access to other services. Evaluation data from 130 clients indicated the service was highly effective in increasing access to multiple services. This study identifies promising system-level and individual interventions that may be effective in increasing health care access for racial minority women.