Health Care Among Street-Involved Women

Abstract

I present the findings from a study that explored the experiences and decision making of street-involved women navigating the health care system. Data were drawn from a larger qualitative study situated in a western Canadian inner-city neighborhood that examined the health-management strategies of street-involved women with a history of crack cocaine use. Data were collected over a 17-month period and included ethnographic methods of participant observation, group interviews (n = 57), and in-depth interviews (n = 10). Inductive thematic analysis derived two major themes: power and punishment, and organization and delivery of care. The themes illustrate how women's experiences and decision making were located within a nexus of power relations that operated across women's shared social location as downtown eastsiders. Implications of the findings are discussed in relation to supporting women's efforts and improving health outcomes.

Homeless persons' experiences of health‐ and social care: A systematic integrative review

“…Twenty-two studies relevant to our aim and research questions were included in the review, 11 quantitative (Asmoredjo, Beijersbergen, & Wolf, 2017;Baggett, O'Connell, Singer, & Rigotti, 2010;Hwang et al, 2010;Jenkins & Parylo, 2011;Kertesz et al, 2014;van Laere, de Wit, & Klazinga, 2009;Robbins, Wenger, Lorvick, Shiboski, & Kral, 2010;Uddin et al, 2009;Vuillermoz, Vandentorren, Brondeel, & Chauvin, 2017;Whelan et al, 2010;Zur & Jones, 2014), and 11 qualitative (Biederman, Gamble, Manson, & Taylor, 2014;Biederman, Nichols, & Lindsey, 2013;Bungay, 2013;Corrigan, Pickett, Kraus, Burks, & Schmidt, 2015;Gültekin, Brush, Baiardi, Kirk, & VanMaldeghem, 2014;Kryda & Compton, 2009;Martins, 2008;McLeod & Walsh, 2014;Nickasch & Marnocha, 2009;Rae & Rees, 2015;Voronka et al, 2014). We found no studies that described economic costs in conjunction with needs of health-and social care in persons experiencing homelessness.…”

“…See Appendix S1 for a presentation of research aims, population foci, methods, samples, key findings and SIGN scores in the included articles. To summarise, 11 studies were conducted in the United States (50%) (Baggett et al, 2010;Biederman et al, 2014Biederman et al, , 2013Corrigan et al, 2015;Gültekin et al, 2014;Kertesz et al, 2014;Kryda & Compton, 2009;Martins, 2008;Nickasch & Marnocha, 2009;Robbins et al, 2010;Zur & Jones, 2014), five in Canada (23%) (Bungay, 2013;Hwang et al, 2010;McLeod & Walsh, 2014;Voronka et al, 2014;Whelan et al, 2010), two in the Netherlands (9%) (Asmoredjo et al, 2017;van Laere et al, 2009), two in the United Kingdom (9%) (Jenkins & Parylo, 2011;Rae & Rees, 2015), one in Bangladesh (4.5%) (Uddin et al, 2009) and one in France (4.5%) (Vuillermoz et al, 2017). The population foci in 12 studies (55%) were persons experiencing homelessness in general (Asmoredjo et al, 2017;Baggett et al, 2010;Biederman et al, 2014;Hwang et al, 2010;Kertesz et al, 2014;Kryda & Compton, 2009;van Laere et al, 2009;Martins, 2008;Nickasch & Marnocha, 2009;Rae & Rees, 2015;Uddin et al, 2009;Voronka et al, 2014), whereas foci in three studies, respectively, were family homelessness (14%) (Gültekin et al, 2014;Jenkins & Parylo, 2011;…”

“…Other population foci (17%) were: African Americans with mental illness experiencing homelessness (Corrigan et al, 2015), injection drug users experiencing homelessness (Robbins et al, 2010), persons visiting a mobile health unit experiencing homelessness (Whelan et al, 2010) and persons visiting federally qualified health centres in the USA experiencing homelessness (Zur & Jones, 2014). In five studies (23%), the samples consisted of only women (Biederman et al, 2013;Bungay, 2013;Gültekin et al, 2014;McLeod & Walsh, 2014;Vuillermoz et al, 2017), whereas Biederman et al (2014) did not report the proportion of females/males that participated in their study. Numbers of study participants in included studies ranged between 6 (Biederman et al, 2014) and 1,191 .…”

“…In 11 studies, persons experiencing homelessness reported how they struggle to accommodate basic human needs, that is, finding food, water, security and shelter (Baggett et al, 2010;Biederman et al, 2014;Bungay, 2013;Corrigan et al, 2015;Gültekin et al, 2014;van Laere et al, 2009;Martins, 2008;Nickasch & Marnocha, 2009;Rae & Rees, 2015;Uddin et al, 2009;Vuillermoz et al, 2017). Food insecurity and lack of nutrition was highlighted (Baggett et al, 2010;Biederman et al, 2014;Corrigan et al, 2015;Gültekin et al, 2014;Nickasch & Marnocha, 2009;Rae & Rees, 2015;Vuillermoz et al, 2017), especially in the light of being exposed to weather and the elements (Corrigan et al, 2015).…”

“…Reasons were: not being covered by insurance or the healthcare system (Baggett et al, 2010;Corrigan et al, 2015;Kertesz et al, 2014;Martins, 2008;Nickasch & Marnocha, 2009), lacking identification (Corrigan et al, 2015), mail and telephone (Nickasch & Marnocha, 2009), poor transportation (Gültekin et al, 2014;Kertesz et al, 2014;Nickasch & Marnocha, 2009) and cuts in dental coverage (Robbins et al, 2010). Examples of strategies employed when meeting these barriers were: giving up medical care (Rae & Rees, 2015), lying about identity to receive care, TA B L E 1 Sub-themes related to included articles Unmet basic human needs Struggle to accommodate basic human needs Baggett et al, 2010;Biederman et al, 2014;Bungay, 2013;Corrigan et al, 1997;Gültekin et al, 2015;Martins, 2015;McLeod & Walsh, 2008;Nickasch & Marnocha, 2018;Rae & Rees, 2015;Uddin et al, 2009;van Laere et al, 2009;Vuillermoz et al, 2017;Zur & Jones, 2014.…”