Barriers and facilitators to health care access for people experiencing homelessness in four European countries: an exploratory qualitative study

International Journal for Equity in Health

Research

Lee Smith¹  Christina Carmichael²  Igor Grabovac³  Tobias Schiffler³  Matina Kouvari⁴  Pania Karnaki⁴  Alejandro Gil-Salmeron⁵  Maria Moudatsou⁶  Ioanna Tabaki⁶  Tamara Alhambra-Borrás⁷  Ascensión Doñate-Martínez⁷ 

[1]Centre for Health, Performance and Wellbeing, Anglia Ruskin University, East Rd, CB1 1PT, Cambridge, UK

[2]Centre for Health, Performance and Wellbeing, Anglia Ruskin University, East Rd, CB1 1PT, Cambridge, UK

[3]School of Psychology, University of East Anglia, Norwich Research Park, NR4 7TJ, Norwich, UK

[4]Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria

[5]Environmental and Occupational Health, PROLEPSIS – Institute of Preventive Medicine, Fragoklisias street 7, 151 25, Athens, Greece

[6]International Foundation for Integrated Care, Linton Road, OX2 6UD, Oxford, UK

[7]International University of Valencia, Calle del Pintor Sorolla, 21, 46002, Valencia, Spain

[8]PRAKSIS – Programs of Development, Social Support and Medical Cooperation, Stournari 57, 104 32, Athens, Greece

[9]Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022, Valencia, Spain

关键词: Homelessness;    Primary health care;    Health care disparities;    Qualitative research;   

DOI  :  10.1186/s12939-023-02011-4

 received in 2022-10-19, accepted in 2023-09-12,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPeople experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context.MethodsWe conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically.ResultsFindings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers.ConclusionsThe results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH’s access to mainstream primary care. This can also be further complemented by investment in ‘in-reach’ services and other tailored and person-centred forms of health care.Trial registrationThis study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 4