IntroductionAccess to health services is a determinant of population health and is known to be reduced for a variety of specialist services for Indigenous populations in Canada. With arthritis being the most common chronic condition experienced by Indigenous populations and causing high levels of disability, it is critical to resolve access disparities through an understanding of barriers and facilitators to care. The objective of this study was to inform future health services reform by investigating health care access from the perspective of Aboriginal people with arthritis and health professionals.MethodsUsing constructivist grounded theory methodology we investigated Indigenous peoples’ experiences in accessing arthritis care through the reports of 16 patients and 15 healthcare providers in Alberta, Canada. Semi-structured interviews were conducted between July 2012 and February 2013 and transcribed verbatim. The patient and provider data were first analyzed separately by two team members then brought together to form a framework. The framework was refined through further analysis following the multidisciplinary research team's discussions. Once the framework was developed, reports on the patient and provider data were shared with each participant group independently and participants were interviewed to assess validity of the summary.ResultsIn the resulting theoretical framework Indigenous participants framed their experience with arthritis as 'toughing it out’ and spoke of racism encountered in the healthcare setting as a deterrent to pursuing care. Healthcare providers were frustrated by high disease severity and missed appointments, and framed Indigenous patients as lacking 'buy-in’. Constraints imposed by complex healthcare systems contributed to tensions between Indigenous peoples and providers.ConclusionLow specialist care utilization rates among Indigenous people cannot be attributed to cultural and social preferences. Further, the assumptions made by providers lead to stereotyping and racism and reinforce rejection of healthcare by patients. Examples of 'working around’ the system were revealed and showed potential for improved utilization of specialist services. This framework has significant implications for health policy and indicates that culturally safe services are a priority in addressing chronic disease management.

The therapeutic arts (TA) encompass a vast area of practices including art, music, drama, dance, and horticultural therapy in multiple settings. However, TA often lack recognition in hospital settings and may be viewed as expendable programming. Credibility and visibility obtained through research was needed to build effective links to partners and policymakers at a pediatric hospital. In terms of research methods, we used participatory action research to guide the process of facilitating the building of research capacity in TA practitioners. We interviewed eight hospital stakeholders to investigate barriers and facilitators to TA research. Interview themes included: barriers to research; strategies to facilitate TA research; research gaps; and practice gaps. Research capacity growth included a shift from a passive role in research to a more active role; this factor occurred alongside the difficulties of juxtaposing research with practitioner duties. We conclude that with a clearer understanding of the hospital research environment, TA practitioners can build support and a social network for research engagement; this process has begun, in part, as a result of this research. R ESUM ELes arts th erapeutiques englobent une vaste gamme de pratiques comprenant l'art, la musique, le th eâtre, la danse et la th erapie par l'horticulture, et ce dans de multiples contextes. Cependant, les arts th erapeutiques sont peu reconnus et trop souvent consid er es comme des programmes non prioritaires en milieu hospitalier. La cr edibilit e et la visibilit e conf er ees par cette recherche ont permis de tisser des liens efficaces avec les partenaires et les d ecideurs dans un hôpital p ediatrique. En termes de m ethodes de recherche, nous avons utilis e la recherche-action pour y guider un processus de renforcement des capacit es en recherche parmi les praticiens des arts th erapeutiques. Nous avons interview e huit parties prenantes de l'hôpital pour etudier les obstacles et les entr ees pour la recherche en arts th erapeutiques. Les th emes d'entrevue ont inclus: les obstacles a la recherche; les strat egies pour faciliter la recherche en arts th erapeutiques; les lacunes de la recherche; et les lacunes dans la pratique. Le renforcement des capacit es en recherche a permis de passer d'un rôle passif dans la recherche a un rôle plus actif; ce facteur s'est produit parall element aux difficult es a combiner la recherche et les fonctions de praticien. Nous concluons qu'en d eveloppant une meilleure compr ehension de l'environnement de recherche de l'hôpital, les praticiens des arts th erapeutiques peuvent obtenir du soutien et construire un r eseau social pour l'engagement en recherche; ce processus a d ej a commenc e, en partie grâce a cette recherche.