title: Negotiating access to a diagnosis of dementia: Implications for policies in health and social care.
abstract: The 'Pathways to Diagnosis' study captured the experience of the prediagnosis period of Alzheimer's disease and related dementias through indepth interviews with 29 persons with dementia and 34 of their family caregivers across four sites: anglophones in Calgary, francophones in Ottawa, Chinese-Canadians in Greater Vancouver and Indo-Canadians in Toronto. In this cross-site analysis, we use the 'Candidacy' framework to comprehensively explore the challenges to securing a diagnosis of dementia in Canada and to develop relevant health and social policy. Candidacy views eligibility for appropriate medical care as a process of joint negotiation between individuals and health services, which can be understood relative to seven dimensions: identification of need, navigation, appearances at services, adjudication by providers, acceptance of/resistance to offers, permeability of services and local conditions. Interviewees experienced challenges relative to each of the seven dimensions and these varied in form and emphasis across the four ethno-linguistic groups.
authors.affiliation: Department of Gerontology, Simon Fraser University, Vancouver, Canada; Providence Health Care, Vancouver, Canada skoehn@sfu.ca.
authors.forename: Sharon
authors.initials: S
authors.lastname: Koehn
authors.affiliation: Department of Gerontology, Simon Fraser University, Vancouver, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Badger
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Carole
authors.initials: C
authors.lastname: Cohen
authors.affiliation: Department of Nursing, Brock University, St. Catherines, Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: McCleary
authors.affiliation: Department of Family Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Drummond
mesh_terms: D000544:Alzheimer Disease / Q000175:diagnosis* / Q000208:ethnology; D002170:Canada; D017028:Caregivers; D003704:Dementia / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D062526:Patient Navigation
keywords: Canada; Candidacy framework; dementia diagnosis; ethnocultural minority older adults; health policy; health services accessibility