Evaluation of an equity, diversity and inclusion program for the healthcare workforce in rural long-term care in Canada

• Pioneering Study on EDI in Rural LTC: First study to systematically evaluate an Equity, Diversity, and Inclusion (EDI) program for the healthcare workforce in a rural long-term care (LTC) setting using a rigorous mixed-methods approach within the Donabedian framework . • Uncovering Unique Barriers & Enablers: Identifies previously unexamined structural and cultural factors influencing EDI implementation, such as work schedule constraints limiting participation and the role of cultural events in fostering inclusivity . • Innovative, Replicable Evaluation Model: Establishes a scalable, evidence-based framework for assessing EDI initiatives in rural healthcare settings, providing actionable insights for policymakers, administrators, and researchers. • Advancing Intersectional & Sustainable EDI Strategies: Highlights the necessity of long-term, intersectional approaches tailored to the complexities of rural LTC environments, ensuring meaningful and enduring systemic change. Growing demand for Long-Term Care (LTC) services highlights the need to address systemic issues within an ethnically and culturally diverse healthcare workforce. To address such challenges in a healthcare setting, an Equity, diversity, and inclusion (EDI) program was developed. This study aimed to evaluate the implementation of the EDI program in a rural LTC facility in Nova Scotia, Canada, using the Donabedian framework. This mixed-methods study involved ninety-two LTC staff members. Participants completed a survey to assess the program relative to the Donabedian framework: Structure (resources and policies), Process (training and implementation), and Outcomes (staff satisfaction, knowledge and participation in EDI activities). Interviews ( n = 4) were conducted to further explore their experiences and perceptions of the program. Descriptive and analytical analysis was employed for the survey data, while qualitative data was explored via reflexive thematic analysis. Participants reported moderate understanding and satisfaction with the program. Responses differed significantly in terms of satisfaction levels based on reported income and religious affiliation. Convergence between qualitative and quantitative data indicated the effectiveness of material facilitation, but staff availability was a limiting factor. Staff were satisfied with the EDI program; however, the results reiterate the need for sustained efforts in rural communities. Improved resources and targeted education for rural healthcare facilities are crucial, and it is essential to consider intersectionality when promoting equity, diversity, inclusion, and accessibility.