The exploration of priority population consumers’ experiences and challenges within healthcare services is critical for improving overall service delivery and ensuring equitable access to care. A core message arising from this research is the importance of recognising and accommodating consumers’ social or group identities, as evidenced in sub-themes related to cultural responsiveness. Concurrently, participants expressed a desire for a nuanced and individualised approach that goes beyond generalised sociocultural categories. This dual emphasis suggests a tension wherein priority population consumers seek acknowledgment of their unique personal identities while remaining aware of and valued within the broader context of their social identities. Research has traditionally focused on personal and social identities as distinct concepts. However, recent studies emphasise a growing recognition of the intertwined nature of personal and social identity, revealing how they interact and influence each other (36, 37).
Challenges may arise when HCPs make assumptions about consumers based on their association with a social identity such as age, culture, or diagnosis, instead of acknowledging their individuality. The ethos behind PEACH focuses on identifying priority population consumers and aims to facilitate earlier, supported, and integrated access to SCHN services, primarily recognising and grouping them from a social identity perspective. However, this research emphasises that while acknowledging the social identity and group affiliation of those in priority populations is important, priority population consumers also seek acknowledgment of their unique personal identities to ensure holistic and tailored care.
The interplay between consumers’ personal and social identities in the provision of healthcare services, along with the significance of affirming a consumer’s self-identity, is a topic that has not been extensively addressed in literature. The published focus is often centred around contexts related to sexuality or uncertainties surrounding gender identity (38, 39). Relevant to the context of PEACH, ongoing variabilities surrounding disability identity remain, particularly concerning the choice between identity-first language, such as ‘disabled person’, and person-first language, such as ‘person with disability’ (40). Individuals with disabilities typically have strong preferences for one type of language over the other, therefore it is important for non-disabled individuals to follow, respect, and validate the language choices of each person with a disability regarding how they wish to be referred to (41).
Previous literature recognises that categorising consumers into specific groups is required for research and data analysis to effectively identify and analyse variations and inequities among different social subgroups. However, as supported by the findings of this study, it is also important for HCPs to ask individuals how they personally identify, as assumptions based on categorisations may be inaccurate (42). For example, people show varying levels and ways of committing to their ethnic group, contributing to congruent and incongruent cultural behaviours, particularly for bicultural individuals (43).
Priority population consumers frequently attributed their positive experiences at SCHN to the favourable interactions they had with individual staff members who exhibited empathy, active listening, and a holistic approach. Previous literature echoes this call for holistic service delivery that integrates a person-centred approach and fosters effective interpersonal communication between HCPs and consumers from various healthcare presentations and population groups. When HCPs establish trust and actively involve CYP in discussions and decisions, this leads to greater satisfaction, increased happiness, and improved willingness to share concerns. Healthcare professionals achieve this by being friendly, knowledgeable, and genuine, connecting with CYP on a personal level, including them in conversations, and using developmentally appropriate language. Conversely, when HCPs fail to connect with or involve CYP, communicate in overly technical terms, or place CYP in a passive role between HCPs and parents, CYP experience fear, anger, resistance, and disengagement (44).
The findings of this study support the adoption of an enhanced centeredness approach to address the intricate interplay between personal and social identities. Ambiguity remains regarding the terminology used to describe the focus of centeredness care in healthcare delivery, encompassing concepts such as family-centred care, child-centred care, and person-centred care (45, 46). Despite variations in terminology, these approaches share common principles, including fostering partnerships, promoting participation, and prioritising ethical values such as dignity and respect. Positive outcomes associated with centredness in healthcare include improved quality of care, increased consumer satisfaction, and improved health outcomes (46). Nonetheless they also suggest consideration of the CYP’s cultural and social context, thereby capturing the interplay between individual and social identities, The development of strategies to enhance the provision of centeredness care within SCHN has the potential to not only enhance experiences for priority population consumers but also improve how HCPs interact with non-priority population consumers.
Implications
From an epidemiological and statistical perspective, it remains important to identify priority population consumers in line with the objectives of PEACH and work towards minimising inequities in their healthcare experiences and outcomes. However, HCPs must also prioritise the delivery of individualised, person-centred care. By identifying individuals within these priority population groups, HCPs can consider relevant risk factors and guide them towards appropriate healthcare pathways that are tailored to their unique circumstances. For example, facilitating connections with Aboriginal healthcare workers where appropriate. As perceived by priority population consumers, an individualised approach to care includes acknowledging the interconnectedness of individuals’ lives, building meaningful connections, ensuring effective interpersonal communication, and demonstrating respect for their diverse identities.
As a result of this research and the quality improvement objectives of SCHN, a key aspect of PEACH implementation will involve embedding a priority population tile into the electronic medical records (eMR) to enhance the identification of priority population consumers. An educational module and script for initiating discussions will be developed and disseminated to staff to enhance their ability to sensitively engage with consumers and determine their personal identification status. It is anticipated that as staff engage in identification conversations with consumers more frequently, this practice will become more ingrained, contributing to enhanced consumer interaction, trust, and quality of care.
While it may take time for changes aimed at addressing inequity to become apparent, this research provides a preliminary perspective of priority population consumers’ experiences before the implementation of PEACH initiatives. Following the integration of PEACH interventions into SCHN service provision, post-implementation experiences can be investigated to better understand the impact on subsequent experiences and inequity reduction.
Limitations
Targets for sample size were realised based on judgement that holding 5–10 interviews with consumers from each priority population group would offer a blend of in-depth individual consumer experiences while also achieving data saturation (29). However, it's important to note that the experiences shared by these participants may not fully represent the experiences of all consumers within the same population group, nor be generalised to experiences outside of the context of SCHN. Despite CALD populations making up the largest proportion of priority population consumers at SCHN and efforts to make recruitment pathways equitable through translated materials, recruitment among CALD individuals proved particularly challenging because CALD is a healthcare-imposed identity rather than a person-centred identity. Most individuals from CALD backgrounds tend to self-identify by their specific background (e.g., Chinese, Indian, Lebanese) rather than as CALD, resulting in very low response rates to recruitment posters and advertising. Moreover, conducting recruitment stalls in the foyer posed difficulties for CALD individuals requiring interpreters, as spontaneous conversations were not feasible. Therefore, CALD individuals needing interpreters may be underrepresented compared to those who are bilingual but also have a CALD background.
By employing purposive and convenience sampling techniques, participation in this study likely attracted individuals who were particularly passionate about the topic and/or confident in sharing their experiences. It is probable that consumers who are less confident, less engaged with services, and less inclined to advocate for themselves may be underrepresented in the study. One objective of recruitment was to ensure the representation of various SCHN departments in the experiences of priority population consumers. However, given the extensive range of hospital departments and treatments, it was not feasible for the study to include representation of every department.
As required, interpreters were used with non-native speakers of English. The use of an interpreter may introduce challenges in effectively capturing the nuances of participants' experiences and perspectives. While bounded by a code of ethics in which interpreters have a responsibility to uphold linguistic neutrality, the act of interpretation inevitably involves biases or cultural assumptions which may subtly influence the portrayal of the consumer’s perspective.