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Miller JP, Hutton J, Doherty C, Vallesi S, Currie J, Rushworth K, Larkin M, Scott M, Morrow J, Wood L. A scoping review examining patient experience and what matters to people experiencing homelessness when seeking healthcare. BMC Health Serv Res 2024; 24:492. [PMID: 38643146 PMCID: PMC11031864 DOI: 10.1186/s12913-024-10971-8] [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] [Received: 07/25/2023] [Accepted: 04/09/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Homelessness is associated with significant health disparities. Conventional health services often fail to address the unique needs and lived experience of homeless individuals and fail to include participatory design when planning health services. This scoping review aimed to examine areas of patient experience that are most frequently reported by people experiencing homelessness when seeking and receiving healthcare, and to identify existing surveys used to measure patient experience for this cohort. METHODS A scoping review was undertaken reported according to the PRISMA-ScR 2020 Statement. Databases were searched on 1 December 2022: MEDLINE, EMBASE, APA PsychINFO and CINAHL. Included studies focused on people experiencing homelessness, healthcare services and patient experience, primary research, published in English from 2010. Qualitative papers and findings were extracted and synthesized against a modified framework based on the National Institute for Health and Care Excellence guidelines for care for people experiencing homelessness, the Institute of Medicine Framework and Lachman's multidimensional quality model. People with lived experience of homelessness were employed as part of the research team. RESULTS Thirty-two studies were included. Of these, 22 were qualitative, seven quantitative and three mixed methods, from the United States of America (n = 17), United Kingdom (n = 5), Australia (n = 5) and Canada (n = 4). Health services ranged from primary healthcare to outpatient management, acute care, emergency care and hospital based healthcare. In qualitative papers, the domains of 'accessible and timely', 'person-centred', and values of 'dignity and respect' and 'kindness with compassion' were most prevalent. Among the three patient experience surveys identified, 'accessible and timely' and 'person-centred' were the most frequent domains. The least frequently highlighted domains and values were 'equitable' and 'holistic'. No questions addressed the 'safety' domain. CONCLUSIONS The Primary Care Quality-Homeless questionnaire best reflected the priorities for healthcare provision that were highlighted in the qualitative studies of people experiencing homelessness. The most frequently cited domains and values that people experiencing homelessness expressed as important when seeking healthcare were reflected in each of the three survey tools to varying degrees. Findings suggest that the principles of 'Kindness and compassion' require further emphasis when seeking feedback on healthcare experiences and the domains of 'safety', 'equitable', and 'efficiency' are not adequately represented in existing patient experience surveys.
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Affiliation(s)
| | - Jennie Hutton
- St Vincent's Hospital Melbourne, Melbourne, Australia.
- The University of Melbourne, Melbourne, Australia.
- Victorian Virtual Emergency Department, Northern Hospital, Melbourne, Australia.
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | | | | | - Jane Currie
- Queensland University of Technology, Brisbane, Australia
| | | | | | - Matthew Scott
- St Vincent's Hospital Melbourne, Melbourne, Australia
- Lived Experience Representative, Melbourne, Australia
| | - James Morrow
- Lived Experience Representative, Melbourne, Australia
| | - Lisa Wood
- The University of Notre Dame Australia, Perth, Australia
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Bartels SA, MacKenzie M, Douglas SL, Collier A, Pritchard J, Purkey E, Messenger D, Walker M. Emergency department care experiences among members of equity-deserving groups: quantitative results from a cross-sectional mixed methods study. BMC Emerg Med 2023; 23:21. [PMID: 36809981 PMCID: PMC9942657 DOI: 10.1186/s12873-023-00792-z] [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] [Received: 11/15/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Emergency departments (EDs) serve an integral role in healthcare, particularly for vulnerable populations. However, marginalized groups often report negative ED experiences, including stigmatizing attitudes and behaviours. We engaged with historically marginalized patients to better understand their ED care experiences. METHOD Participants were invited to complete an anonymous mixed-methods survey about a previous ED experience. We analysed quantitative data including controls and equity-deserving groups (EDGs) - those who self-identified as: (a) Indigenous; (b) having a disability; (c) experiencing mental health issues; (d) a person who uses substances; (e) a sexual and gender minority; (f) a visible minority; (g) experiencing violence; and/or (h) facing homelessness - to identify differences in their perspectives. Differences between EDGs and controls were calculated with chi squared tests, geometric means with confidence ellipses, and the Kruskal-Wallis H test. RESULTS We collected a total of 2114 surveys from 1973 unique participants, 949 controls and 994 who identified as equity-deserving. Members of EDGs were more likely to attribute negative feelings to their ED experience (p < 0.001), to indicate that their identity impacted the care received (p < 0.001), and that they felt disrespected and/or judged while in the ED (p < 0.001). Members of EDGs were also more likely to indicate that they had little control over healthcare decisions (p < 0.001) and that it was more important to be treated with kindness/respect than to receive the best possible care (p < 0.001). CONCLUSION Members of EDGs were more likely to report negative ED care experiences. Equity-deserving individuals felt judged and disrespected by ED staff and felt disempowered to make decisions about their care. Next steps will include contextualizing findings using participants' qualitative data and identifying how to improve ED care experiences among EDGs to make it more inclusive and better able to meet their healthcare needs.
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Affiliation(s)
- Susan A Bartels
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada. .,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
| | - Meredith MacKenzie
- Department of Family Medicine, Queen's University, Kingston, ON, Canada.,Street Health Centre, part of Kingston Community Health Centres, Kingston, ON, Canada
| | - Stuart L Douglas
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.,Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Jodie Pritchard
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Eva Purkey
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - David Messenger
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.,Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Melanie Walker
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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Varcoe C, Browne AJ, Bungay V, Perrin N, Wilson E, Wathen CN, Byres D, Roberta Price E. Through An Equity Lens: Illuminating The Relationships Among Social Inequities, Stigma And Discrimination, And Patient Experiences of Emergency Health Care. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022; 52:246-260. [PMID: 35098791 PMCID: PMC8894974 DOI: 10.1177/00207314221075515] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
People who experience the greatest social inequities often have poor experiences in emergency departments (EDs) so that they are deterred from seeking care, leave without care complete, receive inadequate care, and/or return repeatedly for unresolved problems. However, efforts to measure and monitor experiences of care rarely capture the experiences of people facing the greatest inequities, experiences of discrimination, or relationships among these variables. This analysis examined how patients' experiences, including self-reported ratings of care, experiences of discrimination, and repeat visits vary with social and economic circumstances. Every consecutive person presenting to three diverse EDs was invited if/when they were able to consent; 2424 provided demographic and contact information; and 1692 (70%) completed the survey. Latent class analysis (LCA) using sociodemographic variables: age, gender, financial strain, employment, housing stability, English as first language, born in Canada, and Indigenous identity, indicated a six-class solution. Classes differed significantly on having regular access to primary care, reasons for the visit, and acuity. Classes also differed on self-reported discrimination every day and during their ED visit, ratings of ED care, and number of ED visits within the past six months. ED care can be improved through attention to how intersecting forms of structural disadvantage and inequities affect patient experiences.
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Affiliation(s)
- Colleen Varcoe
- 120487University of British Columbia (UBC), Vancouver BC, Canada
| | - Annette J Browne
- 120487University of British Columbia (UBC), Vancouver BC, Canada
| | - Vicky Bungay
- 120487University of British Columbia (UBC), Vancouver BC, Canada
| | - Nancy Perrin
- 1466Johns Hopkins University, Baltimore, Maryland, USA
| | - Erin Wilson
- 6727University of Northern British Columbia (UNBC), Prince George, British Columbia, Canada
| | | | - David Byres
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
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Nam E, Palmer AN, Patel M. Characteristics of Emergency Department Visits by Homeless Young Adults in the U.S. J Adolesc Health 2021; 69:302-307. [PMID: 33483236 DOI: 10.1016/j.jadohealth.2020.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/25/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Homeless young adults often seek health care at emergency departments (EDs) after they are no longer able to ignore a pressing health problem. However, a dearth of literature examines homeless young adults' ED visits. This study aimed to increase understanding of ED visits among homeless young adults within the U.S. METHODS Data for this study were obtained from the 2011-2015 National Hospital Ambulatory Medical Care Survey. The sample for this study included all ED visits made by homeless and housed young adults aged 18-29 years (unweighted N = 25,068). RESULTS ED visits by homeless young adults were distinguished in terms of gender, region, payment sources, and triage level. Furthermore, ED visits made by homeless young adults were more likely related to mental health and suicide. Homeless young adults' ED visits were characterized by a longer average length of stay and were less likely to be referred to a physician or clinic for follow-up, given medication, or have a procedure performed in the ED. CONCLUSIONS This study highlighted differences in ED utilization for homeless young adults. The findings of this study suggest a need to further examine the characteristics of ED services received by homeless young adults to better understand differences in ED service receipt related to housing status. This knowledge can inform efforts to reduce costs through improving access to housing and outpatient mental health care and reducing stigma among health care professionals to ensure continuity of care.
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Affiliation(s)
- Eunji Nam
- Department of Social Welfare, Incheon National University, Incheon, South Korea.
| | - Ashley N Palmer
- School of Social Work, University of Texas at Arlington, Arlington, Texas
| | - Mansi Patel
- School of Social Work, University of Texas at Arlington, Arlington, Texas
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Peckham A, Wright JG, Marani H, Abdelhalim R, Laxer D, Allin S, Alam N, Marchildon G. Putting the Patient First: A Scoping Review of Patient Desires in Canada. Healthc Policy 2021; 16:46-69. [PMID: 34129478 PMCID: PMC8200834 DOI: 10.12927/hcpol.2021.26499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
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Affiliation(s)
- Allie Peckham
- Assistant Professor, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON
| | - James G Wright
- Chief, Economics, Policy and Research, Ontario Medical Association, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Husayn Marani
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Reham Abdelhalim
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Dara Laxer
- Executive Director, Health Policy and Promotion, Ontario Medical Association, Toronto, ON
| | - Sara Allin
- Director of Operations, North American Observatory on Health Systems and Policies; Assistant Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Nadia Alam
- Past President, Ontario Medical Association, Toronto, ON
| | - Greg Marchildon
- Director, North American Observatory on Health Systems and Policies; Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Hossain R, Dai JH, Jamani S, Ma Z, Dvorani E, Graves E, Burcul I, Strobel S. Hard-to-Reach Populations and Administrative Health Data: A Serial Cross-sectional Study and Application of Data to Improve Interventions for People Experiencing Homelessness. Med Care 2021; 59:S139-S145. [PMID: 33710086 DOI: 10.1097/mlr.0000000000001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intervention studies with vulnerable groups in the emergency department (ED) suffer from lower quality and an absence of administrative health data. We used administrative health data to identify and describe people experiencing homelessness who access EDs, characterize patterns of ED use relative to the general population, and apply findings to inform the design of a peer support program. METHODS We conducted a serial cross-sectional study using administrative health data to examine ED use by people experiencing homelessness and nonhomeless individuals in the Niagara region of Ontario, Canada from April 1, 2010 to March 31, 2018. Outcomes included number of visits; unique patients; group proportions of Canadian Triage and Acuity Scale (CTAS) scores; time spent in emergency; and time to see an MD. Descriptive statistics were generated with t tests for point estimates and a Mann-Whitney U test for distributional measures. RESULTS We included 1,486,699 ED visits. The number of unique people experiencing homelessness ranged from 91 in 2010 to 344 in 2017, trending higher over the study period compared with nonhomeless patients. Rate of visits increased from 1.7 to 2.8 per person. People experiencing homelessness presented later with higher overall acuity compared with the general population. Time in the ED and time to see an MD were greater among people experiencing homelessness. CONCLUSIONS People experiencing homelessness demonstrate increasing visits, worse health, and longer time in the ED when compared with the general population, which may be a burden on both patients and the health care system.
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Affiliation(s)
- Rahat Hossain
- Department of Psychiatry, University of Toronto, Toronto
| | - Jia Hong Dai
- Michael G. DeGroote School of Medicine, McMaster University
| | - Shaila Jamani
- Faculty of Applied Health Sciences, Brock University, St. Catharines
| | - Zechen Ma
- Michael G. DeGroote School of Medicine, McMaster University
| | | | | | - Ivana Burcul
- Michael G. DeGroote School of Medicine, McMaster University
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Deschênes JM, Roy L, Girard N, Abdel-Baki A. Comment aider les jeunes atteints de psychose à éviter l’itinérance ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088183ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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McCallum R, Medved MI, Hiebert-Murphy D, Distasio J, Sareen J, Chateau D. Fixed Nodes of Transience: Narratives of Homelessness and Emergency Department Use. QUALITATIVE HEALTH RESEARCH 2020; 30:1183-1195. [PMID: 31342845 DOI: 10.1177/1049732319862532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Discourse in popular media, public policy, and academic literature contends that people who are homeless frequently make inappropriate use of hospital emergency department (ED) services. Although researchers have investigated the ED experiences of people who are homeless, no previous studies have examined how this population understands the role of the ED in their health care and in their day-to-day lives. In the present study, 16 individuals participated in semistructured interviews regarding their ED experiences, and narrative analysis was applied to their responses. Within the context of narratives of disempowerment and discrimination, participants viewed the ED in differing ways, but they generally interpreted it as a public, accessible space where they could exert agency. ED narratives were also paradoxical, depicting it as a fixed place for transient care, or a place where they were isolated yet felt a sense of belonging. Implications for policy and practice are discussed.
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Affiliation(s)
| | - Maria I Medved
- University of Manitoba, Winnipeg, Manitoba, Canada
- The American University of Paris, Paris, France
| | | | - Jino Distasio
- The University of Winnipeg, Winnipeg, Manitoba, Canada
| | | | - Dan Chateau
- University of Manitoba, Winnipeg, Manitoba, Canada
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Godoy SM, Abrams LS, Barnert ES, Kelly MA, Bath EP. Fierce Autonomy: How Girls and Young Women Impacted by Commercial Sexual Exploitation Perceive Health and Exercise Agency in Health Care Decision-Making. QUALITATIVE HEALTH RESEARCH 2020; 30:1326-1337. [PMID: 32285750 PMCID: PMC8262511 DOI: 10.1177/1049732320913857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Prior research has examined the high health care needs and vulnerabilities faced by survivors of commercial sexual exploitation (CSE), yet their perspectives are frequently absent. We sought to understand the narratives and views of individuals affected by CSE on their bodies, health, and motivations to seek health care treatment. Twenty-one girls and young women ages 15 to 19 years with self-identified histories of CSE participated in the study. All participants had current or prior involvement in the juvenile justice and/or child welfare systems. Data collection included brief questionnaires, followed by semi-structured individual interviews. The interviews took place between March and July 2017 and were analyzed using iterative and inductive techniques, using the shared decision-making model as a guide. "Fierce Autonomy" emerged as a core theme, depicting how past traumas and absence of control led the girls and young women to exercise agency and reclaim autonomy over decisions affecting their health.
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Affiliation(s)
- Sarah M. Godoy
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Laura S. Abrams
- UCLA Luskin School of Public Affairs, Los Angeles, California, USA
| | - Elizabeth S. Barnert
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- UCLA Mattel Children’s Hospital, Los Angeles, California, USA
- UCLA Pediatrics, Los Angeles, California, USA
| | - Mikaela A. Kelly
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Eraka P. Bath
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
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Folayan MO, Obiyan MO, Olaleye AO. Association between water, sanitation, general hygiene and oral hygiene practices of street-involved young people in Southwest Nigeria. BMC Oral Health 2020; 20:32. [PMID: 32005114 PMCID: PMC6995225 DOI: 10.1186/s12903-020-1022-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
Background Oral hygiene practices can be linked to personal hygiene practices, including access to water and other sanitation facilities. The objective of the study was to determine if there is an association between oral hygiene practices and water and sanitation hygiene (WASH) practices among street-involved young people (SIYP). Methods A cross-sectional study recruited SIYP age 10–24 years in two States in Nigeria recruited through respondent-driven sampling in December 2018. Interviewer-administered questionnaires were used to collect data on water access, sanitation, personal and oral hygiene. The instruments used for collecting the data were standardized tools for measuring the phenomena studied. The association between knowledge and practice of oral hygiene; oral hygiene and water, sanitation and hygiene (WASH); and indicators of good oral hygiene were determined using binary logistic regression guided by two models. Results A total of 845 study participants were recruited. The proportion of SIYP with good knowledge of oral hygiene was low (31.2%), and fewer had good oral hygiene practice (8.9%). There were significant associations between knowledge and practice of tooth cleaning, use of fluoride-containing toothpaste, dental flossing, consumption of sugar between meals, and frequency of dental check-ups (p < 0.001 respectively). Respondents with good water collection and storage practices (AOR: 2.01; 95% CI: 1.24–3.24; P = 0.005) and those residing in Lagos (AOR: 2.85; 95% CI: 1.61–5.06; P = 0.001) had a higher likelihood of having good oral hygiene. Conclusion Good oral hygiene practices of SIYP in Nigeria is associated with access to water collection and storage. WASH programs can have an impact on health through improved oral hygiene practices.
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Affiliation(s)
| | - Mary O Obiyan
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Atinuke O Olaleye
- Department of Obstetrics and Gynecology, Babcock University, Ilishan, Nigeria
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Ramsay N, Hossain R, Moore M, Milo M, Brown A. Health Care While Homeless: Barriers, Facilitators, and the Lived Experiences of Homeless Individuals Accessing Health Care in a Canadian Regional Municipality. QUALITATIVE HEALTH RESEARCH 2019; 29:1839-1849. [PMID: 30810072 DOI: 10.1177/1049732319829434] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Persons struggling with housing remain significantly disadvantaged when considering access to health care. Effective advocacy for their needs will require understanding the factors which impact their health care, and which of those most concern patients themselves. A qualitative descriptive study through the lens of a transformative framework was used to identify barriers and facilitators to accessing health care as perceived by people experiencing homelessness in the regional municipality of Niagara, Canada. In-person, semi-structured interviews with 16 participants were completed, and inductive thematic analysis identified nine barriers and eight facilitators. Barriers included affordability, challenges finding primary care, inadequacy of the psychiatric model, inappropriate management, lack of trust in health care providers, poor therapeutic relationships, systemic issues, and transportation and accessibility. Facilitators included accessibility of services, community health care outreach, positive relationships, and shelters coordinating health care. Knowledge of the direct experiences of marginalized individuals can help create new health policies and enhance the provision of clinical care.
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Affiliation(s)
- Natalie Ramsay
- McMaster University, Michael G. DeGroote School of Medicine, Niagara Regional Campus, St. Catharines, Ontario, Canada
| | - Rahat Hossain
- McMaster University, Michael G. DeGroote School of Medicine, Niagara Regional Campus, St. Catharines, Ontario, Canada
| | - Mo Moore
- McMaster University, Michael G. DeGroote School of Medicine, Niagara Regional Campus, St. Catharines, Ontario, Canada
| | - Michael Milo
- McMaster University, Michael G. DeGroote School of Medicine, Niagara Regional Campus, St. Catharines, Ontario, Canada
| | - Allison Brown
- McMaster University, Michael G. DeGroote School of Medicine, Niagara Regional Campus, St. Catharines, Ontario, Canada
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Robards F, Kang M, Usherwood T, Sanci L. How Marginalized Young People Access, Engage With, and Navigate Health-Care Systems in the Digital Age: Systematic Review. J Adolesc Health 2018; 62:365-381. [PMID: 29429819 DOI: 10.1016/j.jadohealth.2017.10.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/08/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE This systematic review examines how marginalized young people access and engage with health services and navigate health-care systems in high-income countries. METHODS Medline, CINAHL, PsychInfo, The University of Sydney Library database, and Google Scholar were searched to identify qualitative and quantitative original research, published from 2006 to 2017, that focused on selected definitions of marginalized young people (12 to 24 years), their parents/carers, and/or health professionals working with these populations. A thematic synthesis was undertaken identifying themes across and between groups on barriers and/or facilitators to access, engagement, and/or navigation of health-care systems. RESULTS Of 1,796 articles identified, 68 studies in the final selection focused on marginalized young people who were homeless (n = 20), living in rural areas (n = 14), of refugee background (n = 11), gender and/or sexuality diverse (n = 11), indigenous (n = 4), low income (n = 4), young offenders (n = 2), or living with a disability (n = 2). Studies were from the United States, Australia, Canada, United Kingdom, New Zealand, and Portugal, including 44 qualitative, 16 quantitative, and 8 mixed-method study types. Sample sizes ranged from 3 to 1,388. Eight themes were identified relating to ability to recognize and understand health issues; service knowledge and attitudes toward help seeking; structural barriers; professionals' knowledge, skills, attitudes; service environments and structures; ability to navigate the health system; youth participation; and technology opportunities. CONCLUSIONS Marginalized young people experience barriers in addition to those common to all young people. Future studies should consider the role of technology in access, engagement, and health system navigation, and the impact of intersectionality between marginalized groups.
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Affiliation(s)
- Fiona Robards
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Westmead, New South Wales, Australia.
| | - Melissa Kang
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Westmead, New South Wales, Australia; Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Tim Usherwood
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Westmead, New South Wales, Australia; The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
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Nicholas DB, Newton AS, Kilmer C, Calhoun A, deJong-Berg MA, Dong K, Hamilton F, McLaughlin AM, Shankar J, Smyth P. The experiences of emergency department use by street-involved youth: Perspectives of health care and community service providers. SOCIAL WORK IN HEALTH CARE 2016; 55:531-544. [PMID: 27351791 DOI: 10.1080/00981389.2016.1183553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Street-involved (SI) youth represent a significant proportion of urban homeless populations. While previous research has identified SI youth as substantial users of emergency department (ED) services and has examined their experiences of ED care, little is known about the experiences and perceptions of the service providers who assist these youth with health care related issues. Using grounded theory, individual interviews and focus groups were conducted with 20 community agency staff serving SI youth, 17 health service providers, two hospital administrators, and two hospital security personnel regarding their experiences in providing or facilitating ED care for SI youth. Results identify differences in expectations between SI youth and hospital staff, along with service issues and gaps, including relational barriers and resource constraints. Implications for practice and policy development are offered.
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Affiliation(s)
- David B Nicholas
- a Faculty of Social Work , University of Calgary, Central and Northern Alberta Region , Edmonton , Alberta , Canada
| | - Amanda S Newton
- b Department of Pediatrics, Faculty of Medicine & Dentistry , University of Alberta , Edmonton , Alberta , Canada
| | - Christopher Kilmer
- a Faculty of Social Work , University of Calgary, Central and Northern Alberta Region , Edmonton , Alberta , Canada
| | - Avery Calhoun
- a Faculty of Social Work , University of Calgary, Central and Northern Alberta Region , Edmonton , Alberta , Canada
| | - Margaret A deJong-Berg
- a Faculty of Social Work , University of Calgary, Central and Northern Alberta Region , Edmonton , Alberta , Canada
| | - Kathryn Dong
- c Department of Emergency Medicine, Faculty of Medicine & Dentistry , University of Alberta , Edmonton , Alberta , Canada
| | - Faye Hamilton
- d School of Social Work , MacEwan University , Edmonton , Alberta , Canada
| | - Anne Marie McLaughlin
- a Faculty of Social Work , University of Calgary, Central and Northern Alberta Region , Edmonton , Alberta , Canada
| | - Janki Shankar
- a Faculty of Social Work , University of Calgary, Central and Northern Alberta Region , Edmonton , Alberta , Canada
| | - Peter Smyth
- e Alberta Human Services, Government of Alberta , Edmonton , Alberta , Canada
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