Barriers to Healthcare Education

Advancing Equity in Healthcare Education: Insights on the CCA RPL Program from Marginalized Groups

The CCA Recognition of Prior Living (RPL) Program in Nova Scotia allows experienced healthcare workers to have their existing experience formally recognized. However, systemic barriers have limited access for marginalized communities, particularly Mi’kmaw (Indigenous) and 2SLGBTQIA+ individuals. Health Associations Nova Scotia (HANS) engaged our team to conduct culturally sensitive focus groups with members of these communities to identify key challenges in curriculum, program accessibility, and systemic biases. Our findings provided actionable recommendations to make a more inclusive and equitable program, ensuring better representation and support for marginalized healthcare workers.

Case Overview

Health Associations Nova Scotia (HANS) sought to address systemic barriers in its Continuing Care Assistant (CCA) Recognition of Prior Learning (RPL) Program, which faced challenges in accessibility, inclusivity, and systemic biases in curriculum materials. For context, the RPL program is a pathway that allows individuals with relevant work experience, training, or education to have their existing skills assessed and recognized, enabling them to fast-track certification as a CCA without completing the full standard training requirements. 

A comprehensive research and engagement initiative was conducted to understand and dismantle these barriers. Through facilitated focus groups with Mi’kmaw (Indigenous) and 2SLGBTQIA+ healthcare workers, co-led by a Mi’kmaw Elder, to ensure cultural sensitivity, the project gathered critical insights from underrepresented voices.

The resulting report delivered to HANS highlighted key systemic barriers and outlined strategic steps toward a more inclusive and accessible RPL program. HAANS is now using these findings to redesign its program to support equity-deserving communities in the healthcare sector better. 

Key Findings

• Limited Awareness & Accessibility of the RPL Program.

  Many participants, including experienced CCAs, were unfamiliar with the RPL process, limiting opportunities for career advancement. Barriers such as travel, financial struggles, and lack of childcare further reduced accessibility.

• Systemic Bias in Curriculum & Cultural Representation.

  The curriculum lacked representation of Indigenous and 2SLGBTQIA+ identities, contributing to experiences of exclusion. Cultural competency and historical trauma were not adequately addressed in training. 

• Workplace Discrimination & Mental Health Impacts.

  Participants shared experiences of discrimination and microaggressions in the workplace. The absence of anti-discrimination policies and adequate mental health supports exacerbated retention issues. 

Solutions

• Enhanced Outreach & Accessibility.

  Recommendations included offering community-based training, increasing online learning opportunities, and utilizing local facilities for small-group, hands-on training. 

• Culturally Responsive Curriculum Development.

  The project advocated for increased Indigenous representation among instructors, integrating traditional knowledge, and mandatory cultural competency training for non-Indigenous CCAs.  

• Policy & Structural Changes.

  The report recommended implementing stronger anti-discrimination policies, improved mental health support for CCAs, and clearer pathways for career progression.

Impact

• Informed Policy & Program Reform.

  HANS is looking into integrating the research findings into its RPL program redesign, ensuring a more equitable and accessible framework for future healthcare workers.

• Strengthened Community Engagement.

  The focus group methodology built trust within Indigenous and 2SLGBTQIA+ communities, creating a more inclusive consultation process in healthcare workforce planning. 

• Advocacy for Systemic Change.

  The project underscored the need for structural improvements in healthcare training, setting a precedent for equitable workforce development initiatives. 

Challenges

1. Delays in Ethical Approvals & Scheduling

• Approval from the Mi’kmaw Ethics Watch (MEW)—a research committee required to review any project involving Indigenous participants—was time-sensitive, delaying the focus group planning and causing scheduling delays. 

2. Participant Recruitment & Engagement

• Due to rescheduling and historical distrust in consultation and research processes (especially from Mi’kmaw and Indigenous groups), initial engagement was lower than expected, requiring increased community outreach.

3. Systemic Barriers Within & Beyond the RPL Program

• Limited awareness of the CCA RPL program is a key barrier preventing potential participants from accessing this type of education.

• Criminal Record Checks (CRC) disproportionately impact marginalized groups and act as an additional barrier to entry. 

• Many challenges faced by participants stemmed from broader systemic issues, such as workplace discrimination, wage inequities, and the lack of recognition for traditional knowledge. This included:

• For 2SLGBTQIA+ participants, program materials often assumed heterosexuality and binary gender identities as the “standard” or “normal,” reinforcing biases and creating further exclusion.

• For Mi’kmaw participants, the Westernized healthcare system often fails to recognize traditional healing practices and Indigenous ways of knowing, leading to a lack of representation and cultural safety in both training programs and workplace settings.

Lessons Learned

1. Community-Led Consultation is Key

• Involving Elders and lived-experience advocates significantly improved engagement and trust, reinforcing the need for co-designed program development.

2. Flexibility & Accessibility Matter

• Programs must consider logistical barriers such as transportation and childcare when designing educational opportunities for diverse communities. 

3. Change Requires Organizational Commitment

• While participant insights provided valuable recommendations, implementing meaningful change requires long-term organizational commitment and accountability. 

• Equity-deserving communities need to see meaningful changes in policies and practices, not just be asked for input.

Our Recommendations

1. Expand Community-Based Training & Support

• Offer in-community learning options to reduce travel barriers.

• Provide additional support for participants facing accessibility challenges, including childcare options and financial assistance. 

2. Strengthen Cultural Competency & Anti-Discrimination Training

• Develop mandatory training on Indigenous and 2SLGBTQIA+ history, systemic barriers, anti-racism, anti-discrimination, and inclusive workplace practices as part of the CCA program curriculum. 

• Ensure diverse representation among educators and program decision-makers, including the board of directors.

3. Implement Long-Term Equity Strategies

• Establish ongoing consultation mechanisms with Indigenous and 2SLGBTQIA+ representatives.

• Integrate traditional knowledge into healthcare training to create culturally safe environments for CCAs and the patients they serve. 

• Revise policies to ensure fairer hiring practices and better mental health benefits, which will actively support Indigenous and 2SLGBTQIA+ employees.