Title : Leashed by systems: A national prospective study of health equity, social determinants of health, and service dog access in Canada
Abstract:
Background: Service dogs function as critical health-support interventions for individuals living with physical, sensory, psychiatric, and chronic health conditions, enabling greater independence, community participation, and management of complex health needs. Despite their recognized benefits, service dog handlers in Canada continue to encounter systemic barriers across housing, healthcare, employment, education, transportation, and public spaces. These barriers represent important but poorly understood social determinants of health that may contribute to health inequities, reduced social participation, psychological distress, and increased reliance on health and social services. Existing research is fragmented, largely descriptive, and lacks robust epidemiological examination of how experiences vary across intersecting dimensions of identity and social position, including gender, disability type, Indigeneity, socioeconomic status, and geography.
Methods: This prospective mixed-methods cohort study will investigate how social, structural, and health system determinants influence the health, wellbeing, and participation of service dog handlers across Canada. A national cohort of 500-800 adult service dog handlers will be recruited and followed over three years using a bilingual (English/French) survey informed by Gender-Based Analysis Plus (GBA+) and Indigenous data sovereignty principles (OCAP®). Baseline and follow-up assessments will measure exposure to access barriers, discrimination, stigma, financial burden, social support, health service utilization, quality of life, mental health, employment and educational participation, and social inclusion. Quantitative analyses will estimate the prevalence and distribution of barriers and outcomes, identify predictors of adverse health and participation outcomes through multivariable modelling, and examine inequities using intersectional epidemiological approaches. A purposive subsample will participate in longitudinal qualitative interviews to explore pathways linking structural conditions to health outcomes. Findings will be integrated through participatory stakeholder engagement to co-develop evidence-informed recommendations for policy and practice.
Expected Results: The study is expected to generate the first national epidemiological evidence describing the health and social consequences of service dog access barriers in Canada. We hypothesize that exposure to discrimination, inconsistent regulatory environments, inadequate accommodations, and financial strain will be associated with poorer mental health, reduced quality of life, diminished workforce and educational participation, and lower levels of social inclusion. We further anticipate that these adverse effects will be disproportionately concentrated among Indigenous peoples, individuals with non-visible disabilities, rural and remote residents, women and gender-diverse individuals, and those experiencing socioeconomic disadvantage, reflecting the cumulative effects of intersecting structural inequities.
Conclusions: This study conceptualizes service dog access as a public health and health equity issue rather than solely a disability accommodation concern. By prospectively examining how social determinants, structural barriers, and policy environments shape health and participation outcomes, the research will provide actionable evidence to inform accessibility legislation, health system planning, disability policy, and population health interventions. Findings will advance understanding of disability-related health inequities in Canada and support the development of equitable, rights-based, and evidence-informed strategies that promote inclusion, participation, and health across diverse populations. The study's integration of epidemiological methods, intersectionality, patient-oriented research, and Indigenous data governance represents a novel contribution to public health scholarship and health equity research.
