Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study

Abstract

BackgroundThe involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of involving these groups in primary care planning have been reported. However, these benefits are rarely felt by those considered marginalised in society and they are often excluded from participating in the process of planning primary care. It has been recommended to employ suitable approaches, such as co-operative and participatory initiatives, to enable marginalised groups to highlight their priorities for care.MethodsThis Participatory Learning and Action (PLA) research study involved 21 members of various marginalised groups who contributed their views about access to primary care. Using a series of PLA techniques for data generation and co-analysis, we explored barriers and facilitators to primary healthcare access from the perspective of migrants, Irish Travellers, homeless people, drug users, sex workers and people living in deprivation, and identified their priorities for action with regard to primary care provision.ResultsFour overarching themes were identified: the home environment, the effects of the ‘two-tier’ healthcare system on engagement, healthcare encounters, and the complex health needs of many in those groups. The study demonstrates that there are many complicated personal and structural barriers to accessing primary healthcare for marginalised groups. There were shared and differential experiences across the groups. Participants also expressed shared priorities for action in the planning and running of primary care services.ConclusionsMembers of marginalised groups have shared priorities for action to improve their access to primary care. If steps are taken to address these, there is scope to impact on more than one marginalised group and to address the existing health inequities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0487-5) contains supplementary material, which is available to authorized users.

Material practices for meaningful engagement: An analysis of participatory learning and action research techniques for data generation and analysis in a health research partnership

“…There is limited knowledge about suitable methods for involving stakeholders in a meaningful (rather than tokenistic) way in health research partnerships . There is evidence that participatory learning and action research approaches and methods seem promising . In line with this, our findings show that the application of specific PLA techniques in RESTORE proved fit for purpose.…”

“…There are some recent positive examples of PLA applied to primary care health research. These studies describe meaningful involvement of migrants and other stakeholders in the development of a guideline to improve communication in cross‐cultural consultations; involvement of people with aphasia, speech and language therapy educators and students in the evaluation of community services for people with aphasia; and involvement of a variety of marginalized groups (sex workers, homeless people, Irish Travellers, migrants and drug users) in the identification of priorities for primary care team activities . However, there has been no detailed analysis of stakeholders’ or researchers’ experiences of PLA techniques for data generation and co‐analysis used within a PLA‐brokered dialogue.…”

Improving equity and cultural responsiveness with marginalised communities: Understanding competing worldviews

“…As such, marginalised communities require greater access to healthcare support in order to address the health inequities they experience. Yet this demand is not neces- (Szczepura, 2005), language (O'Donnell et al, 2016), structural and interpersonal discriminatory practices (Jones, 2000), and poor cultural responsiveness (Heaslip, Hean, & Parker, 2016b;Kings Fund, 2006;Smith & Ruston, 2013).…”

“…Many individuals from marginalised communities find accessing healthcare services challenging. Reasons for this can be multifaceted and include difficulty in accessing services due to physical ability (Heaslip, Hean, & Parker, ), structural barriers (O'Donnell, Tierney, O'Carroll, Nurse, & MacFarlane, ), poorer health literacy (Szczepura, ), language (O'Donnell et al., ), structural and interpersonal discriminatory practices (Jones, ), and poor cultural responsiveness (Heaslip, Hean, & Parker, ; Kings Fund, ; Smith & Ruston, ).…”

Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

“…(21,29,33,44,(46)(47)(48)(49) Health system navigability is enhanced through having coordinated and co-located care, (7,29,33,34,47,(50)(51)(52) through having clear and intuitive patient pathways managed by staff and providers who bring patients along to the next step, (14,33,47,53,54) and through accompanying patients either by link workers or peer advocates. (21,33,(54)(55)(56)(57)(58) Having this kind of support helps patients by providing extra motivation and con dence in seeking health services when needed and navigating institutional locations such as hospitals and clinics, and negotiating patient pathways which may be complex. (33,35,47,54) Peer advocates have a unique understanding of the experience the patient is having and have the ability to meet patients where they are and provide emotional support.…”