Understanding the role of social identity/position in access to primary care providers: An intersectionality approach using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)
Master of Science
Epidemiology and Biostatistics
Ryan, Bridget L.
Primary care (PC) in Canada is concerned with addressing Canadian health needs, especially the most vulnerable. The roles of social identities and positions in having a PC provider has been treated primarily as independent and additive, instead of interdependent and intersecting. A quantitative intersectionality approach using multilevel analysis of individual heterogeneity and discriminatory accuracy examined whether respondents to the Canadian Community Health Survey (2015-2019) had a PC provider based on membership in intersectional strata (constructed using gender, age, immigration status, race, and income). This study found that not all between-stratum variance in the outcome could be explained by additive effects of gender, age, immigration status, race, and income. For 40 intersectional strata, the predicted probability obtained through intersectional methods differed from that obtained through additive methods. There is a need to adopt an intersectional lens to develop research tools, conduct quantitative research, and create targeted interventions to improve PC access.
Summary for Lay Audience
Primary care providers serve as the first point of contact for medical care for many Canadians. Primary care services include preventive care, routine care for acute and chronic conditions, mental health care, maternity and childcare, and end-of-life care. Having a strong primary care system is important because it is associated with better overall health, reduced mortality, reduced health care system costs, and higher satisfaction with health services.
In Canada, all individuals should have access to a primary care provider. However, studies have shown that certain groups, particularly recent immigrants, younger adults, and lower income individuals, were less likely to have a primary care provider. Traditionally, these studies focus on one part of a person’s identity (e.g., age), or they will select a few parts and study them separately. However, the reality for many individuals is that parts of their identity will intertwine (or intersect) to produce unique experiences and barriers that influence whether they have a primary care provider.
In this study, the national Canadian Community Health Survey was used to understand how people with unique combinations of gender, age, immigration status, race, and income categories (e.g., non-immigrant, young, Black women with middle income) differed in whether they had a primary care provider. The goals of this study were to: (1) understand the importance of these unique combinations in predicting whether individuals had a primary care provider, (2) determine which part of one’s identity contributed most to the prediction, and (3) uncover differences in predictions made through traditional methods versus intersectional methods. This study found that (1) the combinations were very good at being able to predict whether one had a primary care provider, (2) age contributed most to this prediction, and (3) there were a number of differences between traditional and intersectional methods in producing predictions.
This study’s findings suggest that the unique barriers produced by the intersecting parts of an individual’s identity should be considered to improve health research, public health policy, and health promotion to improve access to primary care for those who face the most challenges.
He, Jennifer W., "Understanding the role of social identity/position in access to primary care providers: An intersectionality approach using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)" (2022). Electronic Thesis and Dissertation Repository. 8578.