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Table 2 Clusters and statementsa

From: Defining culturally safe primary care for people who use substances: a participatory concept mapping study

I would feel safe going to the doctor if …

Rating of importance, mean (SD)b

Cluster 1 - Act to prevent stigma: Don’t treat me like crap!

4.18 (0.23)

5. I knew that I wouldn’t be judged or labeled

4.23 (0.95)

7. I wasn’t embarrassed, ashamed, or thought they would be disappointed in me

3.88 (1.04)

8. I was treated like a human being, seen as more than my illness

4.44 (0.65)

49. I knew they wouldn’t make assumptions about me without knowing me

4.30 (0.81)

62. They recognized that some issues are hard to talk about, and provided accommodations to help reduce my anxiety

4.07 (0.98)

63. I wasn’t seen as threatening

3.93 (0.96)

69. I knew they would respect boundaries

4.43 (0.86)

Cluster 2 - Hey, I’m human. Treat me right!

4.29 (0.26)

1. They were caring, compassionate, and patient

4.46 (0.58)

2. I knew that they were looking out for me and my health

4.54 (0.68)

3. They treated me fairly, with respect and dignity

4.52 (0.77)

23. They trusted my knowledge of my own health and what works for me, and didn’t talk down to me

4.15 (0.93)

25. They would tell me what they are doing, what my diagnosis is, and what is happening with my care.

4.47 (0.55)

31. They were open to letting me ask for a second opinion, or at least admit it if they don’t know something

4.20 (0.65)

40. They look at me and make eye-contact.

4.04 (0.91)

42. They don’t make irrelevant comments or ask irrelevant questions, but just dealt with the problem at hand.

3.79 (0.88)

48. I knew they would listen to me, take me seriously, and let me ask questions

4.43 (0.69)

Cluster 3 - Uphold professional standards

4.24 (0.19)

16. They would understand and adequately treat my pain

4.37 (0.71)

17. They would get my medications right, not cut me off or over-medicate me

4.44 (0.80)

18. They gave me information about medications, side effects, and interactions

4.25 (0.84)

19. They had up-to-date knowledge on drug interactions and didn’t prescribe me medications that interact with others that I am taking

4.52 (0.74)

27. I had a say in my treatment planning and decisions

4.28 (0.83)

41. They are professional and impartial, and don’t act surprised when I tell them things

4.13 (0.80)

59. My priorities are my doctor’s priorities

4.22 (0.94)

60. I didn’t have to beg for tests

4.00 (0.94)

70. They would ask me more questions

3.98 (0.92)

Cluster 4 - Do you care about me?

3.99 (0.17)

4. The visit wasn’t rushed, and we could talk about more than one problem

3.94 (0.89)

9. I knew that I would get the help that I need, even if that means they have to put in a bit of extra effort

4.23 (0.79)

10. I could see the same doctor and didn’t have to repeat my story each time

3.92 (1.01)

11. The doctor and I trust each other well and have a rapport

4.19 (0.82)

12. They are personable and have a good bedside manner. It’s not just “what’s your name” and “what’s your problem,” but “how are you” and “how is your day?”

3.79 (1.00)

15. I was offered a variety of options, not just medications

4.13 (0.79)

26. Care was holistic (addressed mind, body and spirit) and helped get to the root of underlying problems

3.98 (0.87)

34. They would follow-up or check in with me about my care.

3.77 (1.00)

Cluster 5 - Maintain my confidentiality in a welcoming and comfortable environment

3.87 (0.43)

21. They didn’t ask the reason for my visit in the waiting room, or talk openly about other patients

4.13 (1.02)

22. They wouldn’t diagnose me without knowing me. Don’t misdiagnose me.

4.42 (0.74)

28. I didn’t have to sit in a waiting room for a long time. Being able to book an appointment (online or by phone) is helpful.

3.74 (0.92)

35. The office was comfortable and not institutional

3.28 (1.14)

36. The waiting room wasn’t too small or packed

3.26 (1.13)

38. I could speak with my doctor on the phone

3.37 (1.22)

47. The receptionist and office staff were friendly and welcoming

3.80 (0.99)

55. I could see my file/medical record

3.76 (1.26)

61. I knew that my providers communicated with each other (so bad interactions between medications are avoided, my doctor knows the results from consultations, etc.)

4.15 (0.84)

66. I knew they would record my information accurately

4.57 (0.62)

67. I felt that we were accountable to each other

4.16 (0.68)

68. They were open to feedback or criticism, or there was an easy process for making a complaint

3.76 (0.99)

Cluster 6 - Be a champion for advocacy

3.37 (0.62)

37. Services are easy to access and in safe and non-triggering locations

3.53 (1.18)

44. The doctor or nurse was the same gender as me

2.58 (1.32)

58. A family member, friend or advocate could come with me

3.63 (1.34)

64. The doctor was part of my family circle. This is how it works in Indigenous communities.

2.73 (1.29)

72. I knew I was covered by insurance

4.24 (0.77)

73. They had a safe, discrete location for giving me my pain medication

3.48 (1.11)

Cluster 7 - Acknowledge and accommodate patient needs and circumstances

3.81 (0.54)

20. I knew that my information would be kept confidential and private

4.54 (0.71)

39. It was a multi-service clinic just for people who use drugs or have addictions

3.43 (1.14)

45. It were easier to get contraception

2.89 (1.29)

46. They were not sexually inappropriate

4.26 (0.85)

51. I knew they were a good doctor (if they were highly recommended, or if my friends were using them)

3.76 (0.92)

53. They knew that I only come to the doctor when I am really sick

3.39 (1.14)

54. They would understand if I’m late or if I miss an appointment, and wouldn’t charge me

3.40 (1.19)

56. I knew they wouldn’t force care on me that I don’t want, or do things without my consent

4.48 (0.69)

65. I knew they wouldn’t take my kids away

3.84 (1.07)

71. They understood my circumstances and lack of money.

4.15 (0.84)

Cluster 8 - Don’t red flag me: Recognize addiction as a health issue

4.16 (0.29)

6. I knew that I wouldn’t be treated badly or lectured about my drug use

4.44 (0.77)

13. I wasn’t blacklisted, red-flagged, or refused care

4.35 (0.84)

14. I knew they wouldn’t assume I am drug-seeking or trying to scam the system

4.23 (0.75)

24. They were open to harm reduction

4.02 (0.71)

29. I knew that I could get access to mental health care, even though I use drugs

4.43 (0.65)

30. They know about and can help me to access services and resources for people who use drugs

4.22 (0.63)

32. They have up to date knowledge about drug use and addiction, and understand the connection with mental health

4.38 (0.80)

33. They know where we are coming from and that drug use isn’t all about motivation

3.85 (0.93)

43. I knew that addiction would be treated like any other health problem

4.16 (0.85)

50. I know I wouldn’t be in trouble with the law or treated like a criminal

4.20 (0.81)

52. They are accepting of drug use, so that I could speak openly about it

4.20 (0.83)

57. The doctor can relate to my experiences of drug use

3.43 (1.19)

  1. a Statement numbers appear in Fig. 1
  2. b Ratings vary from 1 (not important) to 5 (very important)