Table 4.

Factors promoting (✔) or limiting (✘) access relative to Candidacy Framework

✘ Factors limiting access	CANDIDACY DIMENSION	✔ Factors promoting access
✘ Rationalizing symptoms  o Preceding events or current conditions  o Cultural attributions	Identification Recognizing the need to seek medical attention	✔ Public and targeted education to address lack of knowledge of symptoms
✘ Lack of information about roles ✘ Lack of clear pathways ✘ Unavailability of specialists with chronic disease knowledge	Navigation Finding and getting to care - usually via primary care provider	✔ Empowered proactive patients (consider intersections of identity) ✔ System navigators
✘ Passive patients minimize need, deservingness ✘ Low awareness of Tx options  o limited decision-making,  o low referral	Appearances P resentation of symptoms to gatekeeper to establish the need for care	✔ Empowered proactive patients (consider intersections of identity) ✔ Health literacy training ✔ Self-efficacy training ✔ Physicians who offer more time, understanding of context
✘ Normalization of symptoms (e.g., aging) ✘ Perceived unavailability of specialists ✘Attributions of symptoms to PlwRA’s behaviour ✘ Cultural incongruity ✘ Limited expertise, time, consideration	Adjudications Gatekeeper’s judgement of symptoms as needing/ deserving of an offer of Tx, screening, referral, etc.	✔ Person-centred care approach  o Respect, shared decision-making  o Clear communication  o Cultural safety ✔ Training, diagnostic tools
✘ Difficulty in identifying effective Tx ✘ Tx incompatible with other goals (e.g., pregnancy) ✘ Burden of Tx (admin, monitoring) ✘ Side effects, long-term adverse health impact ✘ Tx resistance  o Limiting/abstaining from Tx  o Substitution/supplementation (e.g., CAM)	Acceptance / resistance of offers Factors that influence acceptance or resistance to offers	✔ Severity of symptoms (pain/disability) in need of relief ✔ Effective medication ✔ Person-centred education  o Benefits and harms ✔ Availability of appropriate programming  o Expert person-centred guidance  o Flexibility  o Responsiveness to disease limitations
✘ Excess overlapping HC visits ✘ Lack of cultural safety ✘ Conflicting information from different providers ✘ Poor assessment in triage	Permeability of HC system Influence of the configuration of the HC system and HC policies on access	✔ Person-centred/holistic  o Service configuration, policies  o Location, admin ✔ Outreach (esp. rural) ✔ Multidisciplinary teams  o Improve continuity of care ✔ Central intake/triage ✔ Reduce wait times
✘ Rural and remote areas  o Minimal HC staff, facilities  o Distance to services – travel, expense ✘ Unsuitable housing – quality, location ✘ Inflexible employment policies	Local operating conditions Environmental influences beyond the healthcare system	✔ Travelling clinics, telehealth, travel grants
✘ Loss  o Disease symptoms/Tx effects (poss. resistance to Tx to ‘gain control’ over disease, self)  o Physical features, sexuality  o Roles ✘ Social networks that undermine self-determination and personal value ✘ Poor mental health outcomes & social isolation/withdrawal	Embodied self Sense of self altered by disease - modified by intersections of identity, cultural and social context	✔ Social networks that promote self-determination and personal value ✔ Programming that focuses on self-esteem

Key to abbreviations: CAM complementary and alternative medicine, HC healthcare, PCP primary care provider, PlwRA Person/People living with rheumatoid arthritis, Tx treatment