Relocating patients from a specialist homeless healthcare centre to general practices: a multi-perspective study

Smith, Kathrine Gibson; Paudyal, Vibhu; MacLure, Katie; Forbes-McKay, Katrina; Buchanan, Carol; Wilson, Liz; MacLeod, Joan; Smith, Alice L.; Stewart, Derek

doi:10.3399/bjgp18x694577

Cited by 23 publications

(27 citation statements)

References 8 publications

(5 reference statements)

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“…14 The researchers had utilised TDF previously in research involving participants who were homeless. 9,15 Interviews were audiorecorded, transcribed verbatim, and analysed through a thematic framework approach 16 by two researchers and checked by a third researcher before discussion in the team. The first four transcripts were analysed initially to develop a pool of subthemes in addition to those identified from the topic guides.…”

Section: How This Fits Inmentioning

confidence: 99%

“…However, social influences were deemed important in health-seeking behaviour by participants of this study and in the authors' previous work with those who are homeless. 9,14 Given the diverse nature of homelessness and participant experiences, data saturation was not achieved. Lastly, there is a potential risk of response bias as participants may have provided desirable answers for fear of repercussions on the care or treatment they receive.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…8 Barriers to accessing health care can contribute to the worsening of health issues experienced by people who are homeless, due to delayed diagnosis and treatment. It is known that this population is up to 60 times more likely than the general population to attend an accident and emergency (A&E) department, 9 with substance and alcohol misuse commonly linked to such visits. This may indicate points of weakness in the primary healthcare system for people who are homeless.…”

Section: Introductionmentioning

confidence: 99%

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Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK

et al. 2019

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BackgroundAnecdotal reports of people who are homeless being denied access and facing negative experiences of primary health care have often emerged. However, there is a dearth of research exploring this population’s views and experiences of such services.AimTo explore the perspectives of individuals who are homeless on the provision and accessibility of primary healthcare services.Design and settingA qualitative study with individuals who are homeless recruited from three homeless shelters and a specialist primary healthcare centre for the homeless in the West Midlands, England.MethodSemi-structured interviews were audiorecorded, transcribed verbatim, and analysed using a thematic framework approach. The Theoretical Domains Framework (TDF) was used to map the identified barriers in framework analysis.ResultsA total of 22 people who were homeless were recruited. Although some participants described facing no barriers, accounts of being denied registration at general practices and being discharged from hospital onto the streets with no access or referral to primary care providers were described. Services offering support to those with substance misuse issues and mental health problems were deemed to be excluding those with the greatest need. A participant described committing crimes with the intention of going to prison to access health care. High satisfaction was expressed by participants about their experiences at the specialist primary healthcare centre for people who are homeless (SPHCPH).ConclusionParticipants perceived inequality in access, and mostly faced negative experiences, in their use of mainstream services. Changes are imperative to facilitate access to primary health care, improve patient experiences of mainstream services, and to share best practices identified by participants at the SPHCPH.

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Section: How This Fits Inmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK

et al. 2019

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“…Our study also did not involve PEH participation because this event mainly aimed to draw on the voice of the stakeholder groups involved in the care of PEH. However, the researchers drew their prior experiences of working with PEH when informing the discussion plans for this event [25][26][27][28]. Identifying priority areas of research in the future will require consensus and nominal group techniques [29] for participants to agree on the agenda and future priorities.…”

Section: Limitationsmentioning

confidence: 99%

Research priorities in healthcare of persons experiencing homelessness: outcomes of a national multi-disciplinary stakeholder discussion in the United Kingdom

Jagpal

Saunders

Plahe

et al. 2020

Int J Equity Health

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Background: Persons experiencing homelessness (PEH) face up to twelve times higher mortality rates compared to the general population. There is a need to develop, evaluate and implement novel interventions to minimise such inequalities. This paper aims to present outcomes of a national stakeholder engagement event that was conducted to discuss research priorities around healthcare of PEH in the United Kingdom (UK). Main body: A national stakeholder event was organised in Birmingham, UK. This workshop aimed to engage diverse stakeholders from a variety of background including representations from clinical practice, substance misuse, anti-slavery network, public health practice, local authority, homelessness charities, drugs and alcohol services, Public Health England and academia. A total of five key priority areas for research were identified which included: a) interventions to improve access to health services and preventative services; b) interventions to prevent drug and alcohol related deaths; c) improving existing services through quality improvement; d) identifying PEH's preferences of services; and e) interventions to break the link between vulnerabilities, particularly-modern day slavery and homelessness. Effective partnerships across diverse stakeholder groups were deemed to be imperative in developing, testing and implementing novel interventions. Conclusions: Maximising access to services, prevention of early deaths linked to drugs and alcohol, and identifying effective and ineffective policies and programmes were identified as priority research areas in relation to healthcare of PEH. The outcomes of this discussion will enable design and conduct of interdisciplinary research programmes to address the syndemics of homelessness and linked adverse health outcomes. Priorities identified here are likely to be applicable internationally.

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“…TDF has been used extensively in qualitative studies to identify target behaviours for future interventions and to characterise implementation problems (Atkins et al, 2017;Cane et al, 2012). The researchers have previously used TDF in qualitative studies in identifying barriers of: access to primary healthcare by persons experiencing homeless (Gunner et al, 2019) and effective transition of care of such persons across services (Smith, Paudyal, MacLure, et al, 2018). When using TDF, it is imperative that the framework is used from the outset, including the development of an interview schedule, as the use of TDF at later stages of the research provides challenges in mapping the data against TDF domains (Atkins et al, 2017;Cane et al, 2012).…”

Section: Pillars Of Self-carementioning

confidence: 99%

‘If I die, I die, I don’t care about my health’: Perspectives on self‐care of people experiencing homelessness

Paudyal

MacLure

Forbes-McKay

et al. 2019

Health Soc Care Community

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Self‐care, which refers to what people do to prevent disease and maintain good health, can alleviate negative health consequences of people experiencing homelessness. The aim of the study was to apply a theoretically informed approach in exploring engagement of people experiencing homelessness in self‐care and to identify factors that can be targeted in future health and social care interventions. Qualitative semi‐structured interviews were conducted with 28 participants opportunistically recruited from a specialist homelessness healthcare centre of North East Scotland, the United Kingdom (UK). An interview schedule was developed based on the theoretical domains framework (TDF). Interviews were audio‐recorded and transcribed verbatim. Six aspects of self‐care were explored, including (a) self‐awareness of physical and mental health, (b) health literacy, including health seeking behaviour, (c) healthy eating, (d) risk avoidance or mitigation, (v) physical activity and sleep and (e) maintaining personal hygiene. Thematic analysis was conducted by two independent researchers following the Framework Approach. Participants described low engagement in self‐care. Most of the barriers to engagement in self‐care by participants were related to 'environmental context and resources' domain of TDF. Participants often resorted to stealing or begging for food. Many perceived having low health literacy to interpret health‐related information. Visits to churches and charities to get a shower or to obtain free meals were commonplace. Participants expressed pessimism that there was ‘nothing’ they could do to improve their health and described perceived barriers often too big for them to overcome. Alienation, lack of social support and the perception that they had done irreversible damage to their health prevented their involvement in self‐care. The theme of ‘social circle’ held examples of both enabler and barriers in participants’ uptake of risky behaviours. Health and social services should work with persons experiencing homelessness in designing and delivering targeted interventions that address contextual barriers, multi‐morbidity, health literacy and self‐efficacy.

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Relocating patients from a specialist homeless healthcare centre to general practices: a multi-perspective study

Cited by 23 publications

References 8 publications

Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK

Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK

Research priorities in healthcare of persons experiencing homelessness: outcomes of a national multi-disciplinary stakeholder discussion in the United Kingdom

‘If I die, I die, I don’t care about my health’: Perspectives on self‐care of people experiencing homelessness

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