Experience of healthcare among the homeless and vulnerably housed a qualitative study: opportunities for equity-oriented health care

Abstract

Background People experiencing homelessness are often marginalized and are known to face barriers to accessing acceptable and respectful healthcare services. This study examines the experience of accessing hospital-based services of persons experiencing homelessness or vulnerable housing in southeastern Ontario and considers the potential of Equity-Oriented Health Care (EOHC) as an approach to improving care. Methods Focus groups and in-depth interviews with people with lived experience of homelessness (n=31), as well as in-depth interviews of health and social service provider key informants (n=10) were combined with qualitative data from a survey of health and social service providers (n=136). Interview transcripts and written survey responses were analyzed using directed content analysis to examine experiences of people with lived experience of homelessness within the healthcare system. Results Healthcare services were experienced as stigmatizing and shaming particularly for patients with concurrent substance use. These negative experiences could lead to avoidance or abandonment of care. Despite supposed universality, participants felt that the healthcare system was not accountable to them or to other equity-seeking populations. Participants identified a system that was inflexible, designed for a perceived middle-class population, and that failed to take into account the needs and realities of equity-seeking groups. Finally, participants did identify positive healthcare interactions, highlighting the importance of care delivered with dignity, trust, and compassion. Conclusions The experiences of healthcare services among the homeless and vulnerably housed do not meet the standards of universally accessible patient-centered care. EOHC could provide a framework for changes to the healthcare system, creating a system that is more trauma-informed, equity-enhancing, and accessible to people experiencing homelessness, thus limiting identified barriers and negative experiences of care. Electronic supplementary material The online version of this article (10.1186/s12939-019-1004-4) contains supplementary material, which is available to authorized users.

Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study

“…Overall, our study findings suggest that DPs and several CDs are strongly associated in homeless adults, possibly contributing to their poor health profiles. Further, they strongly support the need for proper medical and dental management of these conditions, with primary, secondary and tertiary prevention measures, highlighting the necessity for appropriate, comprehensive and continuous medical care for this population [18,25,27] even within high-income countries such as Canada. Moreover, getting access to dental treatments to mitigate DPs, an area that is not well covered with public insurance in many settings, is also a priority.…”

“…immune response contributing to oral disorders including DPs. It is also possible that the observed associations are due to the poor mental health status [51] combined with the disadvantaged socioeconomic conditions, social exclusion, systemic barriers, and enduring discrimination and stigma faced by homeless people [5,19,25,27,52], which increase their likelihood of having a neglected physical health status and higher burden of chronic comorbidities, including dental diseases.…”

Experiences of Palliative Health Care for Homeless and Vulnerably Housed Individuals

“…Participants painted a vivid portrait of their overall experiences of the health care system. The overwhelming majority of their reports were negative; however, these are reported in another manuscript 22 as they do not pertain specifically to palliative care.…”

The Attitudes of Canadian Ophthalmology Residents and Pre-Clerkship Medical Students at an Ontario Medical School Towards Homeless Individuals: A Cross-Sectional Study

“…For example, experiences of stigmatization, shaming and a feeling of being unwelcome when accessing health care services have been reported. 6,7 Furthermore, it is worthwhile to explore the attitudes of health care professionals towards homeless individuals given that implicit biases can alter decision-making and the quality of clinical care. 8,9 It is particularly important to investigate attitudes towards homelessness in ophthalmology residents and medical students to provide insight into how beliefs evolve during the formative years of medical training.…”