Unmet healthcare needs in homeless women with children in the Greater Paris area in France

Abstract

BackgroundDespite their poor health status, homeless women encounter many barriers to care. The objectives of our study were to estimate the prevalence of unmet healthcare needs in homeless women and to analyse associated relationships with the following factors: financial and spatial access to care, housing history, migration status, healthcare utilisation, victimization history, caring for children, social network and self-perceived health status.MethodsWe used data from 656 homeless women interviewed during the ENFAMS representative survey of sheltered homeless families, conducted in the Paris region in 2013. Structural equation models (SEM) were used to estimate the impact of various factors on homeless women’s unmet healthcare needs.ResultsAmong those interviewed, 25.1% (95%CI[21.3–29.0]) had at least one unmet healthcare need over the previous year. Most had given up on visiting general practitioners and medical specialists. No association with factors related to financial access or to health insurance status was found. However, food insecurity, poor spatial health access and poor self-perceived health were associated with unmet healthcare needs. Self-perceived health appeared to be affected by victimization and depression.DiscussionThe lower prevalence of unmet healthcare needs in homeless women compared with women in stable housing situations suggests that homeless women have lower needs perceptions and/or lower expectations of the healthcare system. This hypothesis is supported by the results from SEM. Strategies to provide better access to care for this population should not only focus on financial interventions but also more broadly on spatial healthcare access, cultural norms, and perceptions of health. Reducing their unmet needs and improving their access to healthcare and prevention must include an improvement in their living, financial and housing conditions.

Homeless persons' experiences of health‐ and social care: A systematic integrative review

“…Unmet healthcare needs were reported in 13 studies (Baggett et al, ; Biederman et al, ; Corrigan et al, ; Hwang et al, ; Kertesz et al, ; van Laere et al, ; Martins, ; Nickasch & Marnocha, ; Rae & Rees, ; Robbins et al, ; Uddin et al, ; Vuillermoz et al, ; Zur & Jones, ). Highest prevalence of unmet need in the past 6 months (82%) was reported in a study of injection drug users in the United States (Robbins et al, ), whereas the lowest prevalence of unmet healthcare needs (17%) was reported in a study from Canada (with universal healthcare), investigating a mixed population of persons experiencing homelessness (Hwang et al, ).…”

“…Twenty‐two studies relevant to our aim and research questions were included in the review, 11 quantitative (Asmoredjo, Beijersbergen, & Wolf, ; Baggett, O'Connell, Singer, & Rigotti, ; Hwang et al, ; Jenkins & Parylo, ; Kertesz et al, ; van Laere, de Wit, & Klazinga, ; Robbins, Wenger, Lorvick, Shiboski, & Kral, ; Uddin et al, ; Vuillermoz, Vandentorren, Brondeel, & Chauvin, ; Whelan et al, ; Zur & Jones, ), and 11 qualitative (Biederman, Gamble, Manson, & Taylor, ; Biederman, Nichols, & Lindsey, ; Bungay, ; Corrigan, Pickett, Kraus, Burks, & Schmidt, ; Gültekin, Brush, Baiardi, Kirk, & VanMaldeghem, ; Kryda & Compton, ; Martins, ; McLeod & Walsh, ; Nickasch & Marnocha, ; Rae & Rees, ; Voronka et al, ). We found no studies that described economic costs in conjunction with needs of health‐ and social care in persons experiencing homelessness.…”

“…To summarise, 11 studies were conducted in the United States (50%) (Baggett et al, ; Biederman et al, , ; Corrigan et al, ; Gültekin et al, ; Kertesz et al, ; Kryda & Compton, ; Martins, ; Nickasch & Marnocha, ; Robbins et al, ; Zur & Jones, ), five in Canada (23%) (Bungay, ; Hwang et al, ; McLeod & Walsh, ; Voronka et al, ; Whelan et al, ), two in the Netherlands (9%) (Asmoredjo et al, ; van Laere et al, ), two in the United Kingdom (9%) (Jenkins & Parylo, ; Rae & Rees, ), one in Bangladesh (4.5%) (Uddin et al, ) and one in France (4.5%) (Vuillermoz et al, ). The population foci in 12 studies (55%) were persons experiencing homelessness in general (Asmoredjo et al, ; Baggett et al, ; Biederman et al, ; Hwang et al, ; Kertesz et al, ; Kryda & Compton, ; van Laere et al, ; Martins, ; Nickasch & Marnocha, ; Rae & Rees, ; Uddin et al, ; Voronka et al, ), whereas foci in three studies, respectively, were family homelessness (14%) (Gültekin et al, ; Jenkins & Parylo, ; Vuillermoz et al, ) and homelessness among women (14%) (Biederman et al, ; Bungay, ; McLeod & Walsh, ). Other population foci (17%) were: African Americans with mental illness experiencing homelessness (Corrigan et al, ), injection drug users experiencing homelessness (Robbins et al, ), persons visiting a mobile health unit experiencing homelessness (Whelan et al, ) and persons visiting federally qualified health centres in the USA experiencing homelessness (Zur & Jones, ).…”

“…Highest prevalence of unmet need in the past 6 months (82%) was reported in a study of injection drug users in the United States (Robbins et al, ), whereas the lowest prevalence of unmet healthcare needs (17%) was reported in a study from Canada (with universal healthcare), investigating a mixed population of persons experiencing homelessness (Hwang et al, ). Need for dental and oral healthcare were reported in five studies, all from the United States (Baggett et al, ; Kertesz et al, ; Robbins et al, ; Vuillermoz et al, ; Zur & Jones, ). Highest prevalence of oral healthcare needs (63%) was self‐reported by injection drug users in Robbins et al () and lowest (41%) as reported by participants in Baggett et al ().…”

“…See Appendix S1 for a presentation of research aims, population foci, methods, samples, key findings and SIGN scores in the included articles. To summarise, 11 studies were conducted in the United States (50%) (Baggett et al, 2010;Biederman et al, 2014Biederman et al, , 2013Corrigan et al, 2015;Gültekin et al, 2014;Kertesz et al, 2014;Kryda & Compton, 2009;Martins, 2008;Nickasch & Marnocha, 2009;Robbins et al, 2010;Zur & Jones, 2014), five in Canada (23%) (Bungay, 2013;Hwang et al, 2010;McLeod & Walsh, 2014;Voronka et al, 2014;Whelan et al, 2010), two in the Netherlands (9%) (Asmoredjo et al, 2017;van Laere et al, 2009), two in the United Kingdom (9%) (Jenkins & Parylo, 2011;Rae & Rees, 2015), one in Bangladesh (4.5%) (Uddin et al, 2009) and one in France (4.5%) (Vuillermoz et al, 2017). The population foci in 12 studies (55%) were persons experiencing homelessness in general (Asmoredjo et al, 2017;Baggett et al, 2010;Biederman et al, 2014;Hwang et al, 2010;Kertesz et al, 2014;Kryda & Compton, 2009;van Laere et al, 2009;Martins, 2008;Nickasch & Marnocha, 2009;Rae & Rees, 2015;Uddin et al, 2009;Voronka et al, 2014), whereas foci in three studies, respectively, were family homelessness (14%) (Gültekin et al, 2014;Jenkins & Parylo, 2011;…”