Barriers to healthcare for American Indians experiencing homelessness

Abstract

Members of American Indian (AI) communities face many barriers to receiving both mental and physical healthcare. These barriers can have a negative effect on overall health. Barriers are compounded for AIs who are also experiencing homelessness, and AI make up a disproportionate percentage of the homeless population nationwide. In-depth semi-structured interviews were conducted with 12 service providers and 16 homeless participants in a mid-size Midwestern city to identify barriers to care for homeless participants. Key barriers identified in this study for homeless participants were: transportation, phone accessibility, discrimination, and cold and bureaucratic cultures of healthcare systems. Major barriers identified by service providers were: access to care, discrimination and mistrust, and restrictive policies. Given generally higher disease prevalence within the homeless population and health disparities within the AI community, steps should be taken to reduce barriers to healthcare.

Moving Beyond Housing: Service Implications for Veterans Entering Permanent Supportive Housing

“…Owning a smartphone was associated with increased use of occupational services, which may be an indication that smartphones are an important component of veterans’ work and educational activities, and may be a useful tool in veterans’ service use and engagement. Among homeless populations, technology-based intervention programs have become increasingly feasible due to the increasing number of homeless persons who own cell phone and other electronic devices (Rhoades et al 2017). A meta-analysis found that 44% to 62% of homeless people owned cell phones (McInnes et al 2013) and a study in Massachusetts reported that 88% of homeless veterans owned a cell phone (of whom 35% had a smartphone; McInnes et al 2014).…”

Understanding measures of racial discrimination and microaggressions among American Indian and Alaska Native college students in the Southwest United States

“…Indigenous scholars posit that historical and contemporary discrimination contribute to health inequities for AI/ANs ([ 12 ]; Walters and Simoni, 2002 [ 58 ]). Similar to research with other populations, discrimination within health care institutions and from health care providers acts as a barrier to health care and contributes to avoidance of seeking health care services [ 13 , 35 , 61 ]. Moreover, discrimination contributes to substance misuse, including early onset use [ 59 , 60 ], diabetes-related distress [ 51 ], diminished self-care [ 16 ], pain, and physical impairment [ 5 ].…”

Sources of Stress Among Midwest American Indian Adults with Type 2 Diabetes

“…Substance abuse (Whitbeck, Hoyt, McMorris, Chen, & Stubben, 2001), depressive symptoms (Walls, Gonzalez, Gladney, & Onello, 2015; Whitbeck, McMorris, Hoyt, Stubben, & LaFromboise, 2002), diabetes-related distress (Sittner, Greenfield, & Walls, 2018), uncontrolled blood glucose (Gonzales, Lambert, Fu, Jacob, & Harding, 2014), and physical pain and impairment (Chae & Walters, 2009) are associated with perceived discrimination. In regard to access to care, perceived discrimination and lateral oppression have been identified as barriers to health care for Indigenous people (Balestrery, 2016; Gonzales et al, 2017; Willie, 2017). Research on interpersonal and other traumas among AIs, help explain disproportionate rates of post-traumatic stress disorder (Beals et al, 2013), cardiovascular disease, chronic pain, depressive symptoms (Tehee et al, 2017), as well as differences in blood glucose levels (Goins, Noonan, Gonzales, Winchester, & Bradley, 2017) and treatment modality among AIs with T2D (Jacob et al, 2013).…”