Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the EQUIhealThY project

Abstract

Introduction: Ensuring access to timely and appropriate primary healthcare for deprived patients is an issue facing all countries, even those with universal healthcare systems. There is a paucity of information on how patients living in a context of material and social deprivation perceive barriers in the healthcare system. This study combines the perspectives of persons living in poverty and of healthcare providers to explore barriers to responsive care for underserved persons with a view to developing equity-focused primary care. Methods: In this participatory action research we used photovoice, together with a method known as 'merging of knowledge and practice' developed by ATD Fourth World, an international community organization working to eradicate poverty. The study was conducted in two teaching primary care practices in the Canadian province of Quebec. Participants consisted of 15 health professionals and six members of ATD Fourth World; approximately 60 group meetings were held. Data were analyzed through thematic analysis, in part with the involvement of persons living in poverty. Results: Three main barriers to responsive care in a context of poverty were highlighted by all participants: the difficult living conditions of people living in poverty, the poor quality of interactions between providers and underserved patients, and the complexity of healthcare system organization and functioning. Conclusion: Our research revealed that unhealthy living conditions prevent persons living in poverty from accessing quality healthcare and maintaining good health. Also, the complexity of the healthcare system's organization and functioning has a negative impact on the interactions with healthcare providers. Changes in policy and practice are needed to address those barriers and to achieve greater equity and provide more responsive care for persons living in poverty.

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

“…The challenges of relying solely on publicly provided care have been reported elsewhere [36]. Further, the finding that the imposition of an ‘out of pocket’ expense, such as the prescription levy, can act as a barrier to medication adherence resonates with the findings of Sinnott et al, who reported on publicly funded patients internationally [77].…”

“…These include issues relating to the way the health system functions for migrants, homeless people, drug users and people living in poverty [31–36]. Patient factors such as mistrust of services and feeling unwanted have been reported for homeless people, Travellers, drug users and migrants [22, 37–41].…”

Analysis of Health and Drug Access Associated with the Purchasing Power of the Ecuadorian Population

“…It has been proposed that healthcare systems can even increase inequalities if they do not consider the needs and socioeconomic living conditions of their population (Loignon et al, 2015). Thus, this study aims to supply an analysis of the health access according to the incomes distribution of the population and their geographical localization.…”

Les enjeux méthodologiques et épistémologiques du croisement des savoirs entre personnes en situation de pauvreté, praticien.ne.s et universitaires

“…L'ensemble des prérequis, conditions et méthodes du croisement des savoirs est synthétisé dans une « charte du Croisement des Savoirs et des Pratiques avec des personnes en situation de pauvreté et d'exclusion sociale » 8 , l'histoire de cette démarche étant par ailleurs bien documentée 9 . Une condition présentée comme primordiale est de partir de l'analyse du vécu, du savoir expérientiel des personnes en situation de pauvreté, pour en faire le point de départ d'une construction de savoirs croisés (De Laat et al, 2015). L'importance de mobiliser des supports non écrits est également soulignée, à travers des mises en scène de récits ou l'utilisation d'images par exemple.…”

“…Nous nous proposons d'établir un parallèle entre épistémologies « post-pauvreté », féministes et postcolonialistes et de tirer quelques fils théoriques et méthodologiques sur les freins et leviers au croisement des savoirs avec les personnes en situation de pauvreté à partir d'une étude de cas, la recherche en croisement des savoirs ÉQUIsanTÉ. Réalisée de 2011 à 2015 au Québec (Montréal et Chicoutimi), cette recherche a mobilisé trois types de « cochercheur.e.s » : des personnes en situation de pauvreté accompagnées de volontaires permanents 2 d'ATD Quart Monde, des chercheures en santé et des professionnel.le.s de santé (De Laat et al, 2014 ;Loignon et al, 2015). L'article s'appuie sur cette expérience de recherche, ainsi que sur une évaluation collective effectuée un an après, qui a permis de revenir sur ses effets en termes de connaissances et d'actions, et d'analyser les freins et leviers au croisement des savoirs 3 .…”