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Table 1 Application of the tool to an example at a micro-level

From: A tool to assess alignment between knowledge and action for health equity

Micro Level Application
Actions are carried out at community or local level
Equity Issues in Healthcare Accessibility
Examples of Possible Actions
Point of Application Discredit Distract Disregard Acknowledge Illuminate Disrupt
In an encounter between a public health nurse (PHN) and an Indigenous woman seeking care for an injection-related abscess, the client expresses anger about her treatment at an emergency room, saying she will never return.
The PHN tells the woman that her recall of the experience was likely inaccurate because of her drug use. The PHN ignores the woman’s comment and suggests that the she consider treatment for substance use. The PHN continues to assess the abscess, pretending not to hear the comment. The PHN continues to assess the abscess, saying, “I know. Many of our clients encounter discrimination in hospitals.” The PHN provides a safe place for the woman to describe what happened and how it affected her, then invites reflection about the issue of system-wide discrimination in hospitals with colleagues in public health. Recognizing the damaging impacts of structural violence, the PHN provides a safe place for the woman to describe what happened, how it affected her, and supports the woman to document the encounter in a patient quality care report.
An emergency room manager develops a unit-level policy for triage encounters.
The policy requires triage staff to approach people appearing to be street-involved with extreme caution because of their violent, unpredictable nature, describing “street-involved” people as “often Aboriginal”. Arguing street-involved people often leave prior to receiving care, the policy requires staff to offer street-involved persons treatment for substance use during triage. The policy is silent on discrimination, focusing on procedural rules for what food or clothing staff are permitted to give to street-involved patients. The policy begins with a purpose statement acknowledging evidence of the impact of racial discrimination on the willingness of street-involved people to seek emergency care, even during critical illness. The policy expands upon the purpose statement described in ‘acknowledge’, requiring staff to ask and respond to patient safety concerns and access to food and shelter prior to discharge. The policy focuses on integrating cultural safety in the emergency room through required training, staff.
A team of researchers prepare a proposal to identify patterns of healthcare services use among street-involved persons in a community.
The proposed study identifies genetic patterns among a group of ‘frequent visitors’ to a local emergency room. The proposed study identifies street-involved people’s healthcare literacy, particularly in understanding when to access alternate services. The proposed study identifies healthcare service use patterns using postal code data to estimate income by neighborhood, where an absent postal code is categorized as ‘street involved’. The proposed study identifies healthcare services use among street-involved persons, including asking questions about experiences of racial and poverty discrimination. The proposed study identifies experiences of structural violence and includes a direct commitment to knowledge translation planning in its design. The proposed study identifies experiences of the impact of a cultural safety training intervention offered to employees and leadership in hospital settings.