title: Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic - patient and professional perceptions of inequity in rehabilitation of chronic pain.
abstract: OBJECTIVE
  To analyse patient and professional perceptions about (in)equity of care and rehabilitation of chronic pain patients from primary health care to assessment at a specialty rehabilitation clinic.
  
  
  METHODS
  This qualitative study consists one focus group interview with eight general practitioners who refer patients to pain rehabilitation clinics, 10 individual interviews with patients who were assessed at a pain rehabilitation clinic and seven interviews with professionals participating in multimodal assessment teams at a pain rehabilitation clinic. Interview analysis was conducted by the grounded theory method.
  
  
  RESULTS
  The core category Via Dolorosa, the way of suffering and pain, captured how gender and sociocultural context may contribute to advantages and disadvantages during patient journeys from primary health care to a pain rehabilitation clinic. Patients and professionals perceived pain as a low-ranking illness, and women and men used different gendered strategies to legitimise the pain and to be taken seriously. Being 'a proper patient ready to change' and having 'likeness' between patients and professionals were viewed as advantageous in rehabilitation of pain patients. Patients with higher educational levels were perceived as easier to interact with and had better access to health care. Professional thoughts about gender norms influenced the rehabilitation options. The rehabilitation programme was seen by several professionals to be better suited for women than men, which could lead to unequal care.
  
  
  CONCLUSIONS
  From an equity and gender perspective, our study highlights the complexity in rehabilitation of chronic pain patients - both from patient and professional perspectives. Awareness of gendered and the biased preconceptions and norms is crucial when professionals struggle to offer equitable health care and rehabilitation.
authors.affiliation: Division for Professional Development, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
authors.forename: Arja
authors.initials: A
authors.lastname: Lehti
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
authors.forename: Anncristine
authors.initials: A
authors.lastname: Fjellman-Wiklund
authors.affiliation: Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Stålnacke
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Anne
authors.initials: A
authors.lastname: Hammarström
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Wiklund
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D059350:Chronic Pain / Q000534:rehabilitation*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D054625:Healthcare Disparities / Q000458:organization & administration*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics / Q000458:organization & administration*; D059408:Pain Management / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research
keywords: chronic pain; equity; gender; qualitative method; rehabilitation