A Qualitative Study on Integrated Care: Case Managers’ Experiences with Migrants, Indigenous Peoples, and Sexual and Gender Diverse Communities

Background: Integrated care interventions, such as case management, play a key role in advancing health equity and inclusion, promoting social justice, and delivering culturally responsive services. This project aimed to better understand the needs, successes and challenges encountered by case managers working with migrant, Indigenous peoples and Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, and Asexual (2SLGBTQIA+) individuals, as well as other sexual and gender identities, in the context of real-life interventions.

Method: A qualitative descriptive study, guided by Sally Thorne’s methodology, was conducted using a participatory approach that actively involved individuals from underrepresented communities. Nine semi-structured interviews were conducted with case managers who have lived experience working with patients with complex needs. These case managers were involved in the V1SAGES approach, an integrated care intervention implemented across three health and social services organizations in Quebec. A committee of eight patient partners (three identifying as migrants, two as Indigenous, and three as 2SLGBTQIA+) contributed to the development of the Interview Guide.

Data were analyzed using an interpretative description thematic analysis. The involvement of individuals with lived experience was central to this project, helping to reduce bias in the research process, foster an inclusive approach, and enable a more nuanced analysis. Results: The study revealed six themes related to the experiences of case managers working with migrants, Indigenous peoples, and 2SLGBTQIA+ communities.

 

First, case managers reported systemic challenges within both health and governmental authorities.

 Second, they described emotional responses such as discomfort when discussing pronouns with 2SLGBTQIA+ patients and feelings of helplessness.

Third, they outlined the various resources and partners mobilized in integrated care, as well as language barriers encountered when patients did not speak the same language. These barriers led to difficulties in mutual understanding and posed challenges in reaching certain patients, especially given the limited access to interpretation services.

Fourth, they discussed professional attitudes and choices, emphasizing flexibility, a personalised approach, and strategies to build trust and foster a culturally safe environment.

Fifth, case managers highlighted the realities and challenges faced by patients, including mistrust, resistance, the burden of difficult life experiences, prejudice, discrimination, exclusion, marginalisation, and barriers to accessing and navigating health services.

Finally, they expressed a need for more training, culturally adapted clinical tools, and better support and information regarding immigration processes. Implications: The results provide valuable insights for partners involved in integrated care programs, especially those working with underserved populations, including migrants, Indigenous peoples, and 2SLBTQIA+ communities. These findings contribute to a better understanding of how integrated care can be adapted to meet the needs of diverse groups and the healthcare providers who support them. It also provides guidance to support the development of integrated care programs that are culturally responsive, with potential relevance for future research and public policies aimed at promoting equity in healthcare delivery across similar contexts. These results will also help us adapt training content and clinical tools for case managers, as well as inform advocacy efforts with health authorities and managers.