1
|
Siersbaek R, O'Donnell C, Parker S, Ford J, Burke S, Ní Cheallaigh C. Social exclusion and its impact on health over the life course: A realist review protocol. HRB Open Res 2023; 6:34. [PMID: 38357513 PMCID: PMC10864819 DOI: 10.12688/hrbopenres.13746.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Background Social exclusion is a process whereby certain individuals are born into or pushed to the margins of society and prevented from participating in social, cultural, economic, and political life. People who experience social exclusion are not afforded the same rights and privileges as other population groups. Socially excluded people often experience poorer outcomes in a variety of domains including health, education, employment, and housing than people with socio-economic privilege. People experiencing social exclusion frequently have higher and more complex health needs and poorer access to healthcare than the general population. The aim of this study is to better understand and explain how social exclusion occurs and how it impacts health over the life course. Methods A realist review will be undertaken. Data will be collected via a systematic search of databases of peer-reviewed literature and further iterative searches of peer-reviewed and other literatures as needed. The following data bases will be searched: MEDLINE, Embase, CINAHL, and ASSIA, using both indexed subject headings in each database and relevant key words. Grey literature will be searched via Google Scholar and relevant websites of organisations that work with populations affected by social exclusion. Conclusion A realist review will be conducted to explain the underlying societal mechanisms which produce social exclusion and related health outcomes in particular contexts affecting excluded population groups across the life course. The study has the potential to inform policy makers and service managers of how and why social exclusion occurs and potential key intervention points to prevent exclusion from happening.
Collapse
Affiliation(s)
- Rikke Siersbaek
- Clinical Medicine, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, D08 W9RT, Ireland
| | - Chris O'Donnell
- Safetynet Primary Care, Catherine Mc Auley Education & Research Centre, Dublin 7, D07 A8NN, Ireland
| | - Sarah Parker
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - John Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, England, EC1M 6BQ, UK
| | - Sara Burke
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Clíona Ní Cheallaigh
- Clinical Medicine, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, D08 W9RT, Ireland
| |
Collapse
|
2
|
Maxwell D, Thomas J, Plassmeyer M. The dynamics of providing street medicine to a geographically diverse homeless population in Hawaii. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2023; 20:743-764. [PMID: 37461307 DOI: 10.1080/26408066.2023.2211067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE Since Hawaii has the highest rate of per capita of persons experiencing homelessness (PEH) in the United States, the purpose of this qualitative evaluation study was to evaluate the experiences of both the providers and clients of a Street Medicine (SM) program serving one side of the island of O'ahu. METHOD This evaluation used Story Inquiry to qualitatively assess one SM program serving one side of the island of O'ahu in Hawa'i. Since the culture in Hawaii is largely based upon stories, a qualitative approach was taken to better understand the lived experiences of PEH who utilized the SM services, as well as provider perspectives. RESULTS The findings of this evaluation include strengths of increased primary care engagement and improved quality of life for PEH; barriers to success included transportation scarcity and limitations of services available. CONCLUSIONS The findings lend implications for new SM programs, including gathering community support, having culturally aware outreach and that mobility and flexibility can overcome health-care barriers for PEH.
Collapse
Affiliation(s)
- December Maxwell
- Thompson School of Social Work & Public Health, The University of Hawai'i at Manoa, Honolulu, United States
| | - Johanna Thomas
- School of Social Work, The University of Arkansas, Honolulu, United States
| | - Mark Plassmeyer
- School of Social Work, The University of Arkansas, Honolulu, United States
| |
Collapse
|
3
|
Anastas TM, Stewart JC, Rand KL, Hirsh AT. Pain in People Experiencing Homelessness: A Scoping Review. Ann Behav Med 2023; 57:288-300. [PMID: 36745022 PMCID: PMC10094969 DOI: 10.1093/abm/kaac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prior work suggests that people experiencing homelessness (PEH) are at heightened risk for developing pain and have a uniquely burdensome pain experience. PURPOSE The aim of this scoping review was to map the current peer-reviewed, published literature on the pain experience of PEH. METHODS In accordance with the US Annual Homeless Assessment Report, we defined homelessness as lacking shelter or a fixed address within the last year. We conceptualized the pain experience via a modified version of the Social Communication Model of Pain, which considers patient, provider, and contextual factors. Published articles were identified with CINHAL, Embase, PubMed, PsycINFO, and Web of Science databases. RESULTS Sixty-nine studies met inclusion criteria. Studies revealed that PEH have high rates of pain and experience high levels of pain intensity and interference. Substantially fewer studies examined other factors relevant to the pain experience, such as self-management, treatment-seeking behaviors, and pain management within healthcare settings. Nonetheless, initial evidence suggests that pain is undermanaged in PEH. CONCLUSIONS Future research directions to understand pain and homelessness are discussed, including factors contributing to the under-management of pain. This scoping review may inform future work to develop interventions to address the specific pain care needs of PEH.
Collapse
Affiliation(s)
- Tracy M Anastas
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| |
Collapse
|
4
|
McNeill S, O'Donovan D, Hart N. Access to healthcare for people experiencing homelessness in the UK and Ireland: a scoping review. BMC Health Serv Res 2022; 22:910. [PMID: 35831884 PMCID: PMC9281084 DOI: 10.1186/s12913-022-08265-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background People experiencing homelessness (PEH) have poorer physical and mental health than the general population. They are also more likely to have less access to healthcare. These processes of access can be better understood using Levesque’s access framework which addresses both supply (service provision) and demand (user abilities). Methods Following the Joanna Briggs Institute (JBI) guidelines, electronic peer-reviewed databases were searched in February 2022 for studies published since 2000 related to access to healthcare for PEH ages 16 and older in the United Kingdom (UK) and Ireland. Retrieved articles were screened and those eligible were selected for data extraction. Qualitative and quantitative studies were included. Results Fifty-six papers out of 538 identified were selected and aliased. Six main themes were identified: staff education, flexibility of systems, service coordination, patient preparedness, complex health needs and holistic care. These relate to the Levesque access framework. Conclusions Improving access to healthcare for PEH requires changes to how services are provided and how service-user abilities are supported. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08265-y.
Collapse
Affiliation(s)
- Sarah McNeill
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast, Northern Ireland, BT12 6BA.
| | - Diarmuid O'Donovan
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast, Northern Ireland, BT12 6BA
| | - Nigel Hart
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast, Northern Ireland, BT12 6BA
| |
Collapse
|
5
|
Bennett-Daly G, Maxwell H, Bridgman H. The Health Needs of Regionally Based Individuals Who Experience Homelessness: Perspectives of Service Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8368. [PMID: 35886228 PMCID: PMC9316847 DOI: 10.3390/ijerph19148368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/07/2022]
Abstract
The bidirectional relationship between homelessness and poor health and the barriers that individuals who experience homelessness face when trying to access healthcare are well documented. There is, however, little Australian research exploring the situation of individuals who experience homelessness in regional contexts and, moreover, from the perspective of service providers. A qualitative descriptive methodology underpinned this study, with in-depth semi-structured interviews being conducted with 11 service providers to identify barriers to care faced by people who experience homelessness and barriers that service providers themselves experience in supporting this population. The key barriers identified were client-level barriers: living day-by-day, financial, health literacy, mental health conditions, behaviour, safety and stigma; provider-level barriers: few bulk-billing doctors, fragmented services, limited resources, negative past experiences with healthcare; and system level barriers: transportation, over-stretched healthcare services. The combined impact of these barriers has significantly contributed to the desperate situation of people experiencing homelessness in Launceston. This situation is likely replicated in other regional populations in Australia. Given that individuals experiencing homelessness have higher rates of every measure in health inequality, steps need to be taken to reduce barriers, and a standardised approach to health care urgently needs to be implemented by governments at the state and national level to improve the health of regionally based individuals experiencing homelessness.
Collapse
Affiliation(s)
- Grace Bennett-Daly
- School of Nursing, University of Tasmania, Newnham, Launceston, TAS 7248, Australia;
| | - Hazel Maxwell
- School of Health Sciences, University of Tasmania, Rozelle, Sydney, NSW 2015, Australia
| | - Heather Bridgman
- Centre for Rural Health, University of Tasmania, Newnham, Launceston, TAS 7248, Australia;
| |
Collapse
|
6
|
Maestrelli LG, Sousa Martins Silva A, de Azevedo-Marques Périco C, Torales J, Ventriglio A, Castaldelli-Maia JM. Homelessness and Depressive Symptoms: A Systematic Review. J Nerv Ment Dis 2022; 210:380-389. [PMID: 35413031 DOI: 10.1097/nmd.0000000000001453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The present systematic review aimed to summarize data on the prevalence and treatment of depressive symptoms among homeless people. We referred to the PubMed and Google Scholar databases to identify relevant studies on the topic. Among the 43 included studies, we found great variability in the prevalence of depressive symptoms among homeless people (ranging from 9.9% to 77.5%). Comparative studies among the homeless versus nonhomeless population showed that rates of depressive symptoms are 5 to 14 times higher in the homeless population. Similar differences were also found for suicidal ideation. The lack of research and treatment plans for this specific population further encourages more evidence and special therapeutic intervention. Although little has been found in the literature, a substantial improvement in the quality of life and reduction in depressive symptoms was demonstrated when therapeutic interventions were performed among homeless people (i.e., housing, nursing, access to community care and effective services and supports programs, mindfulness, pharmacological treatment).
Collapse
Affiliation(s)
| | | | | | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, Asunción, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | |
Collapse
|
7
|
Sritart H, Tuntiwong K, Miyazaki H, Taertulakarn S. Disparities in Healthcare Services and Spatial Assessments of Mobile Health Clinics in the Border Regions of Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10782. [PMID: 34682527 PMCID: PMC8535297 DOI: 10.3390/ijerph182010782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 01/21/2023]
Abstract
Reducing the disparities in healthcare access is one of the important goals in healthcare services and is significant for national health. However, measuring the complexity of access in truly underserved areas is the critical step in designing and implementing healthcare policy to improve those services and to provide additional support. Even though there are methods and tools for modeling healthcare accessibility, the context of data is challenging to interpret at the local level for targeted program implementation due to its complexity. Therefore, the purpose of this study is to develop a concise and context-specific methodology for assessing disparities for a remote province in Thailand to assist in the development and expansion of the efficient use of additional mobile health clinics. We applied the geographic information system (GIS) methodology with the travel time-based approach to visualize and analyze the concealed information of spatial data in the finer analysis resolution of the study area, which was located in the border region of the country, Ubon Ratchathani, to identify the regional differences in healthcare allocation. Our results highlight the significantly inadequate level of accessibility to healthcare services in the regions. We found that over 253,000 of the population lived more than half an hour away from a hospital. Moreover, the relationships of the vulnerable residents and underserved regions across the province are underlined in the study and substantially discussed in terms of expansion of mobile health delivery to embrace the barrier of travel duration to reach healthcare facilities. Accordingly, this research study addresses regional disparities and provides valuable references for governmental authorities and health planners in healthcare strategy design and intervention to minimize the inequalities in healthcare services.
Collapse
Affiliation(s)
- Hiranya Sritart
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand;
| | - Kuson Tuntiwong
- School of Dentistry, King Mongkut’s Institute of Technology Ladkrabang, Bangkok 10520, Thailand;
| | - Hiroyuki Miyazaki
- Center for Spatial Information Science, Tokyo University, Chiba 277-8568, Japan;
| | - Somchat Taertulakarn
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand;
| |
Collapse
|
8
|
Lin LP, Wang LY, Wang TW, Chen YC, Lin JD. Factors Associated with Free Hospital Outpatient Service Use among Middle-Aged and Older Urban Homeless Adults in Taipei. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105330. [PMID: 34067784 PMCID: PMC8156856 DOI: 10.3390/ijerph18105330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Homeless individuals have many negative experiences with inequality regarding access to and the use of primary healthcare services, so policies to eliminate the disparities in and barriers to primary care access for these people are needed. The aim of this study was to explore the use and determinants of free hospital outpatient services for homeless people, in order to describe the provision of free healthcare policies for this vulnerable population in Taipei. One cross-sectional survey was conducted to recruit homeless people aged 45 years old and over in Taipei in 2018. A structured questionnaire was used, and face-to-face interviews were conducted by three social workers to collect the data. Finally, 129 participants were recruited in the study. The results show that 81.4% of the homeless people had made free hospital outpatient care visits (mean = 5.9 visits) in the last three months. An unadjusted logistic regression analysis showed that those homeless people who reported having usual healthcare providers, with higher depressive symptom scores, who used medication and had been hospitalized within one year, and had more chronic diseases, were significantly more likely to make free hospital outpatient visits. The adjusted logistic regression model indicates that homeless people with severe depressive symptoms (odds ratio (OR) = 9.32, 95% CI = 1.15–56.07), who had received medication (OR = 3.93; 95% CI = 1.06–14.52), and who had more than five chronic diseases (OR = 1.06, 95% CI = 1.35–13.27), were significantly more likely to make free hospital outpatient visits than their counterparts. The findings highlight that homeless people have higher healthcare requirements than the general population, and the healthcare system should pay more attention to factors associated with higher outpatient service use, such as homelessness, severe depressive symptoms, the receipt of medication and chronic diseases.
Collapse
Affiliation(s)
- Lan-Ping Lin
- Department of Senior Citizen Care and Welfare, Ching Kuo Institute of Management and Health, Keelung 203, Taiwan;
| | - Li-Yun Wang
- Department of Family Studies and Child Development, Shih Chien University, Taipei 104, Taiwan;
| | - Tai-Wen Wang
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan; (T.-W.W.); (Y.-C.C.)
| | - Yun-Cheng Chen
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan; (T.-W.W.); (Y.-C.C.)
| | - Jin-Ding Lin
- Department of Family Studies and Child Development, Shih Chien University, Taipei 104, Taiwan;
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan; (T.-W.W.); (Y.-C.C.)
- Institute of Long-Term Care, Mackay Medical College, New Taipei City 252, Taiwan
- Correspondence:
| |
Collapse
|